| National Provider Identifier [NPI]: | 1538219134 |
| Last Name Of The Provider | FISHBACK |
| First Name Of The Provider | SHELBY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | UNIVERSITY OF KANSAS MEDICAL CENTER RADIOLOGY |
| Street Address 2 Of The Provider | 3901 RAINBOW BLVD |
| City Of The Provider | KANSAS CITY |
| Zip Code Of The Provider | 661600001 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 1856 |
| Number Of Medicare Beneficiaries | 1376 |
| Total Submitted Charge Amount | 340923 |
| Total Medicare Allowed Amount | 73319.51 |
| Total Medicare Payment Amount | 55636.7 |
| Total Medicare Standardized Payment Amount | 59321.97 |
| 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 | 106 |
| Number Of Medical Services | 1856 |
| Number Of Medicare Beneficiaries With Medical Services | 1376 |
| Total Medical Submitted Charge Amount | 340923 |
| Total Medical Medicare Allowed Amount | 73319.51 |
| Total Medical Medicare Payment Amount | 55636.7 |
| Total Medical Medicare Standardized Payment Amount | 59321.97 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 400 |
| Number Of Beneficiaries Age 65 to 74 | 548 |
| Number Of Beneficiaries Age 75 to 84 | 321 |
| Number Of Beneficiaries Age Greater 84 | 107 |
| Number Of Female Beneficiaries | 654 |
| Number Of Male Beneficiaries | 722 |
| Number Of Non Hispanic White Beneficiaries | 1072 |
| Number Of Black or African American Beneficiaries | 212 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1036 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 340 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.3465 |