| National Provider Identifier [NPI]: | 1578556486 |
| Last Name Of The Provider | BALI |
| First Name Of The Provider | SHAMMI |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 SW SAINT LUCIE WEST BLVD |
| Street Address 2 Of The Provider | STE 209 |
| City Of The Provider | PORT SAINT LUCIE |
| Zip Code Of The Provider | 349861780 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 561 |
| Number Of Medicare Beneficiaries | 78 |
| Total Submitted Charge Amount | 43156 |
| Total Medicare Allowed Amount | 24014.75 |
| Total Medicare Payment Amount | 18388.02 |
| Total Medicare Standardized Payment Amount | 17642.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 1860 |
| Total Drug Medicare AllowedAmount | 1153.25 |
| Total Drug Medicare PaymentAmount | 1124.65 |
| Total Drug Medicare Standardized Payment Amount | 1124.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 508 |
| Number Of Medicare Beneficiaries With Medical Services | 78 |
| Total Medical Submitted Charge Amount | 41296 |
| Total Medical Medicare Allowed Amount | 22861.5 |
| Total Medical Medicare Payment Amount | 17263.37 |
| Total Medical Medicare Standardized Payment Amount | 16517.53 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 36 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 40 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | 58 |
| 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 | 62 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9953 |