National Provider Identifier [NPI]: |
1265691935 |
Last Name Of The Provider |
SHAHDA |
First Name Of The Provider |
SAFI |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
535 BARNHILL DR RM 473 |
Street Address 2 Of The Provider |
|
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462025116 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Hematology/Oncology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
14 |
Number Of Services |
536 |
Number Of Medicare Beneficiaries |
211 |
Total Submitted Charge Amount |
123750 |
Total Medicare Allowed Amount |
48168.22 |
Total Medicare Payment Amount |
36486.17 |
Total Medicare Standardized Payment Amount |
38399.13 |
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 |
14 |
Number Of Medical Services |
536 |
Number Of Medicare Beneficiaries With Medical Services |
211 |
Total Medical Submitted Charge Amount |
123750 |
Total Medical Medicare Allowed Amount |
48168.22 |
Total Medical Medicare Payment Amount |
36486.17 |
Total Medical Medicare Standardized Payment Amount |
38399.13 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
58 |
Number Of Beneficiaries Age 65 to 74 |
98 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
106 |
Number Of Male Beneficiaries |
105 |
Number Of Non Hispanic White Beneficiaries |
145 |
Number Of Black or African American Beneficiaries |
55 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
128 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
83 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
53 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
24 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.1148 |