| National Provider Identifier [NPI]: | 1790120012 |
| Last Name Of The Provider | AHSAN |
| First Name Of The Provider | SUNDUS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | P.A.-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6101 DEMPSTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MORTON GROVE |
| Zip Code Of The Provider | 600532952 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 768 |
| Number Of Medicare Beneficiaries | 402 |
| Total Submitted Charge Amount | 119643 |
| Total Medicare Allowed Amount | 82662.56 |
| Total Medicare Payment Amount | 63646.66 |
| Total Medicare Standardized Payment Amount | 70658.5 |
| 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 | 768 |
| Number Of Medicare Beneficiaries With Medical Services | 402 |
| Total Medical Submitted Charge Amount | 119643 |
| Total Medical Medicare Allowed Amount | 82662.56 |
| Total Medical Medicare Payment Amount | 63646.66 |
| Total Medical Medicare Standardized Payment Amount | 70658.5 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 232 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 51 |
| Number Of Black or African American Beneficiaries | 311 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 113 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 289 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 41 |
| Percent Of With Asthma | 26 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 69 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 72 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.3036 |