| National Provider Identifier [NPI]: | 1194879338 |
| Last Name Of The Provider | DALAL |
| First Name Of The Provider | SHAMSHAR |
| 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 | 3400 SPRUCE ST |
| Street Address 2 Of The Provider | 1 MALONEY BUILDING |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191044206 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 1297 |
| Number Of Medicare Beneficiaries | 426 |
| Total Submitted Charge Amount | 1264918.45 |
| Total Medicare Allowed Amount | 96951.77 |
| Total Medicare Payment Amount | 73549.43 |
| Total Medicare Standardized Payment Amount | 72561.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 575 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 3646.45 |
| Total Drug Medicare AllowedAmount | 367.24 |
| Total Drug Medicare PaymentAmount | 241.58 |
| Total Drug Medicare Standardized Payment Amount | 241.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 722 |
| Number Of Medicare Beneficiaries With Medical Services | 426 |
| Total Medical Submitted Charge Amount | 1261272 |
| Total Medical Medicare Allowed Amount | 96584.53 |
| Total Medical Medicare Payment Amount | 73307.85 |
| Total Medical Medicare Standardized Payment Amount | 72319.61 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 181 |
| Number Of Non Hispanic White Beneficiaries | 407 |
| Number Of Black or African American Beneficiaries | |
| 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 | 307 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 24 |
| Average HCC Risk Score Of Beneficiaries | 1.3547 |