| National Provider Identifier [NPI]: | 1710939566 |
| Last Name Of The Provider | SHIDHAM |
| First Name Of The Provider | VINOD |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3990 JOHN R ST |
| Street Address 2 Of The Provider | HARPER HOSPITAL PATHOLOGY |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482012018 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 1321 |
| Number Of Medicare Beneficiaries | 679 |
| Total Submitted Charge Amount | 162504 |
| Total Medicare Allowed Amount | 49598.32 |
| Total Medicare Payment Amount | 38119.04 |
| Total Medicare Standardized Payment Amount | 34028.46 |
| 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 | 29 |
| Number Of Medical Services | 1321 |
| Number Of Medicare Beneficiaries With Medical Services | 679 |
| Total Medical Submitted Charge Amount | 162504 |
| Total Medical Medicare Allowed Amount | 49598.32 |
| Total Medical Medicare Payment Amount | 38119.04 |
| Total Medical Medicare Standardized Payment Amount | 34028.46 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 253 |
| Number Of Beneficiaries Age 65 to 74 | 257 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 411 |
| Number Of Male Beneficiaries | 268 |
| Number Of Non Hispanic White Beneficiaries | 210 |
| Number Of Black or African American Beneficiaries | 443 |
| 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 | 364 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 315 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.2999 |