| National Provider Identifier [NPI]: | 1548251069 |
| Last Name Of The Provider | SHAMIM |
| First Name Of The Provider | EJAZ |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9224 NAGLE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MORTON GROVE |
| Zip Code Of The Provider | 600531428 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 109 |
| Number Of Services | 1908 |
| Number Of Medicare Beneficiaries | 1254 |
| Total Submitted Charge Amount | 317124 |
| Total Medicare Allowed Amount | 93536.9 |
| Total Medicare Payment Amount | 66695.82 |
| Total Medicare Standardized Payment Amount | 63054.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 109 |
| Number Of Medical Services | 1908 |
| Number Of Medicare Beneficiaries With Medical Services | 1254 |
| Total Medical Submitted Charge Amount | 317124 |
| Total Medical Medicare Allowed Amount | 93536.9 |
| Total Medical Medicare Payment Amount | 66695.82 |
| Total Medical Medicare Standardized Payment Amount | 63054.78 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 513 |
| Number Of Beneficiaries Age 65 to 74 | 444 |
| Number Of Beneficiaries Age 75 to 84 | 238 |
| Number Of Beneficiaries Age Greater 84 | 59 |
| Number Of Female Beneficiaries | 662 |
| Number Of Male Beneficiaries | 592 |
| Number Of Non Hispanic White Beneficiaries | 241 |
| Number Of Black or African American Beneficiaries | 652 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 310 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 455 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 799 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.6612 |