| National Provider Identifier [NPI]: | 1831190834 |
| Last Name Of The Provider | RUSTOM |
| First Name Of The Provider | AMAL |
| Middle Initial Of The Provider | Y |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7691 POPLAR AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GERMANTOWN |
| Zip Code Of The Provider | 381383904 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1585 |
| Number Of Medicare Beneficiaries | 1028 |
| Total Submitted Charge Amount | 482066 |
| Total Medicare Allowed Amount | 181138.67 |
| Total Medicare Payment Amount | 138513.69 |
| Total Medicare Standardized Payment Amount | 146294.46 |
| 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 | 41 |
| Number Of Medical Services | 1585 |
| Number Of Medicare Beneficiaries With Medical Services | 1028 |
| Total Medical Submitted Charge Amount | 482066 |
| Total Medical Medicare Allowed Amount | 181138.67 |
| Total Medical Medicare Payment Amount | 138513.69 |
| Total Medical Medicare Standardized Payment Amount | 146294.46 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 149 |
| Number Of Beneficiaries Age 65 to 74 | 337 |
| Number Of Beneficiaries Age 75 to 84 | 318 |
| Number Of Beneficiaries Age Greater 84 | 224 |
| Number Of Female Beneficiaries | 668 |
| Number Of Male Beneficiaries | 360 |
| Number Of Non Hispanic White Beneficiaries | 729 |
| Number Of Black or African American Beneficiaries | 275 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 825 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 203 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7823 |