| National Provider Identifier [NPI]: | 1528492360 |
| Last Name Of The Provider | OMOSANYA |
| First Name Of The Provider | IDRIS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PT, DPT |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18356 MYRTLE CT |
| Street Address 2 Of The Provider | UNIT 8 |
| City Of The Provider | LANSING |
| Zip Code Of The Provider | 604383342 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Therapist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 2147 |
| Number Of Medicare Beneficiaries | 47 |
| Total Submitted Charge Amount | 114505 |
| Total Medicare Allowed Amount | 63512.27 |
| Total Medicare Payment Amount | 49650.07 |
| Total Medicare Standardized Payment Amount | 33717.06 |
| 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 | 10 |
| Number Of Medical Services | 2147 |
| Number Of Medicare Beneficiaries With Medical Services | 47 |
| Total Medical Submitted Charge Amount | 114505 |
| Total Medical Medicare Allowed Amount | 63512.27 |
| Total Medical Medicare Payment Amount | 49650.07 |
| Total Medical Medicare Standardized Payment Amount | 33717.06 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 20 |
| Number Of Beneficiaries Age 75 to 84 | 12 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 29 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 19 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 26 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 55 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 68 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 74 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.8051 |