| National Provider Identifier [NPI]: | 1932193166 |
| Last Name Of The Provider | SHACK |
| First Name Of The Provider | EVAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 CARNIE BLVD |
| Street Address 2 Of The Provider | SUITE B-5 |
| City Of The Provider | VOORHEES |
| Zip Code Of The Provider | 080434512 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 141 |
| Number Of Services | 38554.6 |
| Number Of Medicare Beneficiaries | 2437 |
| Total Submitted Charge Amount | 2622746 |
| Total Medicare Allowed Amount | 563368.18 |
| Total Medicare Payment Amount | 430296.68 |
| Total Medicare Standardized Payment Amount | 397942.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 35415.6 |
| Number Of Medicare Beneficiaries With Drug Services | 549 |
| Total Drug Submitted ChargeAmount | 52639 |
| Total Drug Medicare AllowedAmount | 13775.56 |
| Total Drug Medicare PaymentAmount | 10748.95 |
| Total Drug Medicare Standardized Payment Amount | 10748.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 3139 |
| Number Of Medicare Beneficiaries With Medical Services | 2437 |
| Total Medical Submitted Charge Amount | 2570107 |
| Total Medical Medicare Allowed Amount | 549592.62 |
| Total Medical Medicare Payment Amount | 419547.73 |
| Total Medical Medicare Standardized Payment Amount | 387193.46 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 292 |
| Number Of Beneficiaries Age 65 to 74 | 1043 |
| Number Of Beneficiaries Age 75 to 84 | 707 |
| Number Of Beneficiaries Age Greater 84 | 395 |
| Number Of Female Beneficiaries | 1437 |
| Number Of Male Beneficiaries | 1000 |
| Number Of Non Hispanic White Beneficiaries | 2040 |
| Number Of Black or African American Beneficiaries | 240 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2141 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 296 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5739 |