| National Provider Identifier [NPI]: | 1346283090 |
| Last Name Of The Provider | RAI |
| First Name Of The Provider | SHIWALI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2909 B MCKINNEY AVENUE |
| Street Address 2 Of The Provider | CITYDOC UPTOWN URGENT CARE CENTER |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 75204 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 468 |
| Number Of Medicare Beneficiaries | 224 |
| Total Submitted Charge Amount | 46298 |
| Total Medicare Allowed Amount | 30303.5 |
| Total Medicare Payment Amount | 20524.02 |
| Total Medicare Standardized Payment Amount | 20183.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 1857 |
| Total Drug Medicare AllowedAmount | 183.55 |
| Total Drug Medicare PaymentAmount | 141.51 |
| Total Drug Medicare Standardized Payment Amount | 141.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 423 |
| Number Of Medicare Beneficiaries With Medical Services | 224 |
| Total Medical Submitted Charge Amount | 44441 |
| Total Medical Medicare Allowed Amount | 30119.95 |
| Total Medical Medicare Payment Amount | 20382.51 |
| Total Medical Medicare Standardized Payment Amount | 20042.25 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 116 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 145 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 209 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8079 |