| National Provider Identifier [NPI]: | 1194923326 |
| Last Name Of The Provider | SHAMTOUB |
| First Name Of The Provider | SHERVIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1401 SOUTH GRAND AVENUE. |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 90015 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 6424 |
| Number Of Medicare Beneficiaries | 1256 |
| Total Submitted Charge Amount | 490837.58 |
| Total Medicare Allowed Amount | 375719.19 |
| Total Medicare Payment Amount | 293762.86 |
| Total Medicare Standardized Payment Amount | 268577.73 |
| 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 | 39 |
| Number Of Medical Services | 6424 |
| Number Of Medicare Beneficiaries With Medical Services | 1256 |
| Total Medical Submitted Charge Amount | 490837.58 |
| Total Medical Medicare Allowed Amount | 375719.19 |
| Total Medical Medicare Payment Amount | 293762.86 |
| Total Medical Medicare Standardized Payment Amount | 268577.73 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 359 |
| Number Of Beneficiaries Age 75 to 84 | 557 |
| Number Of Beneficiaries Age Greater 84 | 239 |
| Number Of Female Beneficiaries | 764 |
| Number Of Male Beneficiaries | 492 |
| Number Of Non Hispanic White Beneficiaries | 989 |
| Number Of Black or African American Beneficiaries | 54 |
| Number Of AsianPacific Islander Beneficiaries | 49 |
| Number Of Hispanic Beneficiaries | 73 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 91 |
| Number Of Beneficiaries With Medicare Only Entitlement | 62 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1194 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 50 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 57 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 2.1387 |