| National Provider Identifier [NPI]: | 1730451576 |
| Last Name Of The Provider | IBRAHIM |
| First Name Of The Provider | SAMAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10010 KENNERLY RD |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631282106 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 171 |
| Number Of Services | 23805 |
| Number Of Medicare Beneficiaries | 2683 |
| Total Submitted Charge Amount | 1129381 |
| Total Medicare Allowed Amount | 205636.17 |
| Total Medicare Payment Amount | 157333.12 |
| Total Medicare Standardized Payment Amount | 156980.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 19287 |
| Number Of Medicare Beneficiaries With Drug Services | 166 |
| Total Drug Submitted ChargeAmount | 78804 |
| Total Drug Medicare AllowedAmount | 4132.5 |
| Total Drug Medicare PaymentAmount | 3214.41 |
| Total Drug Medicare Standardized Payment Amount | 3214.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 168 |
| Number Of Medical Services | 4518 |
| Number Of Medicare Beneficiaries With Medical Services | 2682 |
| Total Medical Submitted Charge Amount | 1050577 |
| Total Medical Medicare Allowed Amount | 201503.67 |
| Total Medical Medicare Payment Amount | 154118.71 |
| Total Medical Medicare Standardized Payment Amount | 153766.09 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 716 |
| Number Of Beneficiaries Age 65 to 74 | 981 |
| Number Of Beneficiaries Age 75 to 84 | 712 |
| Number Of Beneficiaries Age Greater 84 | 274 |
| Number Of Female Beneficiaries | 1567 |
| Number Of Male Beneficiaries | 1116 |
| Number Of Non Hispanic White Beneficiaries | 920 |
| Number Of Black or African American Beneficiaries | 1273 |
| Number Of AsianPacific Islander Beneficiaries | 46 |
| Number Of Hispanic Beneficiaries | 405 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1343 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1340 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.3539 |