| National Provider Identifier [NPI]: | 1629086046 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | SUSHRUT |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3998 RED LION ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191141436 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 3172 |
| Number Of Medicare Beneficiaries | 2157 |
| Total Submitted Charge Amount | 503114 |
| Total Medicare Allowed Amount | 146694.53 |
| Total Medicare Payment Amount | 113366.58 |
| Total Medicare Standardized Payment Amount | 109111.96 |
| 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 | 162 |
| Number Of Medical Services | 3172 |
| Number Of Medicare Beneficiaries With Medical Services | 2157 |
| Total Medical Submitted Charge Amount | 503114 |
| Total Medical Medicare Allowed Amount | 146694.53 |
| Total Medical Medicare Payment Amount | 113366.58 |
| Total Medical Medicare Standardized Payment Amount | 109111.96 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 500 |
| Number Of Beneficiaries Age 65 to 74 | 737 |
| Number Of Beneficiaries Age 75 to 84 | 493 |
| Number Of Beneficiaries Age Greater 84 | 427 |
| Number Of Female Beneficiaries | 1215 |
| Number Of Male Beneficiaries | 942 |
| Number Of Non Hispanic White Beneficiaries | 1733 |
| Number Of Black or African American Beneficiaries | 309 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 69 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1434 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 723 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.0062 |