| National Provider Identifier [NPI]: | 1912009168 |
| Last Name Of The Provider | ITANI |
| First Name Of The Provider | NABIL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 875 CENTURY MEDICAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | TITUSVILLE |
| Zip Code Of The Provider | 327962142 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 7224 |
| Number Of Medicare Beneficiaries | 915 |
| Total Submitted Charge Amount | 622090 |
| Total Medicare Allowed Amount | 477729.21 |
| Total Medicare Payment Amount | 362059.94 |
| Total Medicare Standardized Payment Amount | 366626.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 624 |
| Number Of Medicare Beneficiaries With Drug Services | 379 |
| Total Drug Submitted ChargeAmount | 18320 |
| Total Drug Medicare AllowedAmount | 10361.69 |
| Total Drug Medicare PaymentAmount | 9997.25 |
| Total Drug Medicare Standardized Payment Amount | 9997.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 6600 |
| Number Of Medicare Beneficiaries With Medical Services | 915 |
| Total Medical Submitted Charge Amount | 603770 |
| Total Medical Medicare Allowed Amount | 467367.52 |
| Total Medical Medicare Payment Amount | 352062.69 |
| Total Medical Medicare Standardized Payment Amount | 356629.28 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 158 |
| Number Of Beneficiaries Age 65 to 74 | 363 |
| Number Of Beneficiaries Age 75 to 84 | 272 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 512 |
| Number Of Male Beneficiaries | 403 |
| Number Of Non Hispanic White Beneficiaries | 848 |
| Number Of Black or African American Beneficiaries | 38 |
| 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 | 679 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 236 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5966 |