| National Provider Identifier [NPI]: | 1053391524 |
| Last Name Of The Provider | IHMEIDAN |
| First Name Of The Provider | ISMAIL |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1001 TOWSON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT SMITH |
| Zip Code Of The Provider | 729014921 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 276 |
| Number Of Services | 11810 |
| Number Of Medicare Beneficiaries | 5374 |
| Total Submitted Charge Amount | 1134608 |
| Total Medicare Allowed Amount | 360200.11 |
| Total Medicare Payment Amount | 272654.46 |
| Total Medicare Standardized Payment Amount | 292838.43 |
| 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 | 276 |
| Number Of Medical Services | 11810 |
| Number Of Medicare Beneficiaries With Medical Services | 5374 |
| Total Medical Submitted Charge Amount | 1134608 |
| Total Medical Medicare Allowed Amount | 360200.11 |
| Total Medical Medicare Payment Amount | 272654.46 |
| Total Medical Medicare Standardized Payment Amount | 292838.43 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1376 |
| Number Of Beneficiaries Age 65 to 74 | 1851 |
| Number Of Beneficiaries Age 75 to 84 | 1516 |
| Number Of Beneficiaries Age Greater 84 | 631 |
| Number Of Female Beneficiaries | 3221 |
| Number Of Male Beneficiaries | 2153 |
| Number Of Non Hispanic White Beneficiaries | 4684 |
| Number Of Black or African American Beneficiaries | 225 |
| Number Of AsianPacific Islander Beneficiaries | 39 |
| Number Of Hispanic Beneficiaries | 88 |
| Number Of American Indian Alaska Native Beneficiaries | 312 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3446 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1928 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7413 |