| National Provider Identifier [NPI]: | 1992995542 |
| Last Name Of The Provider | ITTIARA |
| First Name Of The Provider | SHAUN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2525 S MICHIGAN AVE |
| Street Address 2 Of The Provider | 8TH FLOOR EYE CENTER |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606162333 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 2373 |
| Number Of Medicare Beneficiaries | 569 |
| Total Submitted Charge Amount | 724714 |
| Total Medicare Allowed Amount | 357091.04 |
| Total Medicare Payment Amount | 270813.21 |
| Total Medicare Standardized Payment Amount | 257944.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 437 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 119514 |
| Total Drug Medicare AllowedAmount | 93292.12 |
| Total Drug Medicare PaymentAmount | 71527.89 |
| Total Drug Medicare Standardized Payment Amount | 71527.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 1936 |
| Number Of Medicare Beneficiaries With Medical Services | 569 |
| Total Medical Submitted Charge Amount | 605200 |
| Total Medical Medicare Allowed Amount | 263798.92 |
| Total Medical Medicare Payment Amount | 199285.32 |
| Total Medical Medicare Standardized Payment Amount | 186416.22 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 238 |
| Number Of Beneficiaries Age 75 to 84 | 169 |
| Number Of Beneficiaries Age Greater 84 | 91 |
| Number Of Female Beneficiaries | 379 |
| Number Of Male Beneficiaries | 190 |
| Number Of Non Hispanic White Beneficiaries | 106 |
| Number Of Black or African American Beneficiaries | 371 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 65 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 201 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6501 |