| National Provider Identifier [NPI]: | 1356674493 |
| Last Name Of The Provider | SHAW |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | D.O., |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9089 BASELINE RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | RANCHO CUCAMONGA |
| Zip Code Of The Provider | 917301295 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 945 |
| Number Of Medicare Beneficiaries | 295 |
| Total Submitted Charge Amount | 155021 |
| Total Medicare Allowed Amount | 110938.96 |
| Total Medicare Payment Amount | 81746.35 |
| Total Medicare Standardized Payment Amount | 75088.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 65 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 2189 |
| Total Drug Medicare AllowedAmount | 1515.1 |
| Total Drug Medicare PaymentAmount | 1481.92 |
| Total Drug Medicare Standardized Payment Amount | 1481.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 880 |
| Number Of Medicare Beneficiaries With Medical Services | 295 |
| Total Medical Submitted Charge Amount | 152832 |
| Total Medical Medicare Allowed Amount | 109423.86 |
| Total Medical Medicare Payment Amount | 80264.43 |
| Total Medical Medicare Standardized Payment Amount | 73606.82 |
| Average Age Of Beneficiaries | 84 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 60 |
| Number Of Beneficiaries Age Greater 84 | 180 |
| Number Of Female Beneficiaries | 208 |
| Number Of Male Beneficiaries | 87 |
| Number Of Non Hispanic White Beneficiaries | 249 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 244 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 65 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 2.0539 |