| National Provider Identifier [NPI]: | 1184697484 |
| Last Name Of The Provider | BACKUS |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 838 MARKET STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | ZANESVILLE |
| Zip Code Of The Provider | 43701 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 250 |
| Number Of Services | 8054 |
| Number Of Medicare Beneficiaries | 4457 |
| Total Submitted Charge Amount | 909776.86 |
| Total Medicare Allowed Amount | 236844.44 |
| Total Medicare Payment Amount | 178064.28 |
| Total Medicare Standardized Payment Amount | 184301.06 |
| 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 | 250 |
| Number Of Medical Services | 8054 |
| Number Of Medicare Beneficiaries With Medical Services | 4457 |
| Total Medical Submitted Charge Amount | 909776.86 |
| Total Medical Medicare Allowed Amount | 236844.44 |
| Total Medical Medicare Payment Amount | 178064.28 |
| Total Medical Medicare Standardized Payment Amount | 184301.06 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1136 |
| Number Of Beneficiaries Age 65 to 74 | 1520 |
| Number Of Beneficiaries Age 75 to 84 | 1226 |
| Number Of Beneficiaries Age Greater 84 | 575 |
| Number Of Female Beneficiaries | 2733 |
| Number Of Male Beneficiaries | 1724 |
| Number Of Non Hispanic White Beneficiaries | 4253 |
| Number Of Black or African American Beneficiaries | 143 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1673 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5187 |