| National Provider Identifier [NPI]: | 1437360864 |
| Last Name Of The Provider | DALAL |
| First Name Of The Provider | TEJAS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 HARRINGTON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT CLEMENS |
| Zip Code Of The Provider | 480432920 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 14195 |
| Number Of Medicare Beneficiaries | 2667 |
| Total Submitted Charge Amount | 1155312.65 |
| Total Medicare Allowed Amount | 281427.05 |
| Total Medicare Payment Amount | 217933.04 |
| Total Medicare Standardized Payment Amount | 214934.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 9576 |
| Number Of Medicare Beneficiaries With Drug Services | 129 |
| Total Drug Submitted ChargeAmount | 13775 |
| Total Drug Medicare AllowedAmount | 4855.86 |
| Total Drug Medicare PaymentAmount | 3758.91 |
| Total Drug Medicare Standardized Payment Amount | 3758.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 158 |
| Number Of Medical Services | 4619 |
| Number Of Medicare Beneficiaries With Medical Services | 2667 |
| Total Medical Submitted Charge Amount | 1141537.65 |
| Total Medical Medicare Allowed Amount | 276571.19 |
| Total Medical Medicare Payment Amount | 214174.13 |
| Total Medical Medicare Standardized Payment Amount | 211175.67 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 766 |
| Number Of Beneficiaries Age 65 to 74 | 887 |
| Number Of Beneficiaries Age 75 to 84 | 659 |
| Number Of Beneficiaries Age Greater 84 | 355 |
| Number Of Female Beneficiaries | 1533 |
| Number Of Male Beneficiaries | 1134 |
| Number Of Non Hispanic White Beneficiaries | 2250 |
| Number Of Black or African American Beneficiaries | 316 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1822 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 845 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.0256 |