| National Provider Identifier [NPI]: | 1861485740 |
| Last Name Of The Provider | ELSAMALOTY |
| First Name Of The Provider | HAITHAM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3000 ARLINGTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436142595 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 192 |
| Number Of Services | 4187 |
| Number Of Medicare Beneficiaries | 2079 |
| Total Submitted Charge Amount | 366266.83 |
| Total Medicare Allowed Amount | 122934.57 |
| Total Medicare Payment Amount | 95057.89 |
| Total Medicare Standardized Payment Amount | 97202.73 |
| 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 | 192 |
| Number Of Medical Services | 4187 |
| Number Of Medicare Beneficiaries With Medical Services | 2079 |
| Total Medical Submitted Charge Amount | 366266.83 |
| Total Medical Medicare Allowed Amount | 122934.57 |
| Total Medical Medicare Payment Amount | 95057.89 |
| Total Medical Medicare Standardized Payment Amount | 97202.73 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 758 |
| Number Of Beneficiaries Age 65 to 74 | 662 |
| Number Of Beneficiaries Age 75 to 84 | 452 |
| Number Of Beneficiaries Age Greater 84 | 207 |
| Number Of Female Beneficiaries | 1221 |
| Number Of Male Beneficiaries | 858 |
| Number Of Non Hispanic White Beneficiaries | 1474 |
| Number Of Black or African American Beneficiaries | 480 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1143 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 936 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.1285 |