| National Provider Identifier [NPI]: | 1790758308 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | VIPUL |
| 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 | 1606 N 7TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TERRE HAUTE |
| Zip Code Of The Provider | 478042706 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 206 |
| Number Of Services | 8674 |
| Number Of Medicare Beneficiaries | 4892 |
| Total Submitted Charge Amount | 1144684 |
| Total Medicare Allowed Amount | 301226.44 |
| Total Medicare Payment Amount | 228687.93 |
| Total Medicare Standardized Payment Amount | 243133.99 |
| 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 | 206 |
| Number Of Medical Services | 8674 |
| Number Of Medicare Beneficiaries With Medical Services | 4892 |
| Total Medical Submitted Charge Amount | 1144684 |
| Total Medical Medicare Allowed Amount | 301226.44 |
| Total Medical Medicare Payment Amount | 228687.93 |
| Total Medical Medicare Standardized Payment Amount | 243133.99 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1090 |
| Number Of Beneficiaries Age 65 to 74 | 1750 |
| Number Of Beneficiaries Age 75 to 84 | 1292 |
| Number Of Beneficiaries Age Greater 84 | 760 |
| Number Of Female Beneficiaries | 2880 |
| Number Of Male Beneficiaries | 2012 |
| Number Of Non Hispanic White Beneficiaries | 4692 |
| Number Of Black or African American Beneficiaries | 113 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3407 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1485 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6858 |