| National Provider Identifier [NPI]: | 1013925395 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | DEVINA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11240 S MICHIGAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606284941 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 381 |
| Number Of Medicare Beneficiaries | 74 |
| Total Submitted Charge Amount | 37742 |
| Total Medicare Allowed Amount | 28616.66 |
| Total Medicare Payment Amount | 20264.88 |
| Total Medicare Standardized Payment Amount | 19214.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 880 |
| Total Drug Medicare AllowedAmount | 264.88 |
| Total Drug Medicare PaymentAmount | 259.6 |
| Total Drug Medicare Standardized Payment Amount | 259.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 359 |
| Number Of Medicare Beneficiaries With Medical Services | 74 |
| Total Medical Submitted Charge Amount | 36862 |
| Total Medical Medicare Allowed Amount | 28351.78 |
| Total Medical Medicare Payment Amount | 20005.28 |
| Total Medical Medicare Standardized Payment Amount | 18954.65 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 55 |
| Number Of Male Beneficiaries | 19 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 25 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8837 |