| National Provider Identifier [NPI]: | 1740439009 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | JAI |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D., M.B.A., M.P.H. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 S MILWAUKEE AVE |
| Street Address 2 Of The Provider | ADVOCATE CONDELL MEDICAL CENTER - RADIOLOGY DEPARTMENT |
| City Of The Provider | LIBERTYVILLE |
| Zip Code Of The Provider | 600483204 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 229 |
| Number Of Services | 4039 |
| Number Of Medicare Beneficiaries | 2114 |
| Total Submitted Charge Amount | 915559 |
| Total Medicare Allowed Amount | 220857.59 |
| Total Medicare Payment Amount | 168479.6 |
| Total Medicare Standardized Payment Amount | 157285.85 |
| 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 | 229 |
| Number Of Medical Services | 4039 |
| Number Of Medicare Beneficiaries With Medical Services | 2114 |
| Total Medical Submitted Charge Amount | 915559 |
| Total Medical Medicare Allowed Amount | 220857.59 |
| Total Medical Medicare Payment Amount | 168479.6 |
| Total Medical Medicare Standardized Payment Amount | 157285.85 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 277 |
| Number Of Beneficiaries Age 65 to 74 | 678 |
| Number Of Beneficiaries Age 75 to 84 | 680 |
| Number Of Beneficiaries Age Greater 84 | 479 |
| Number Of Female Beneficiaries | 1207 |
| Number Of Male Beneficiaries | 907 |
| Number Of Non Hispanic White Beneficiaries | 1782 |
| Number Of Black or African American Beneficiaries | 100 |
| Number Of AsianPacific Islander Beneficiaries | 56 |
| Number Of Hispanic Beneficiaries | 145 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1660 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 454 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.1543 |