| National Provider Identifier [NPI]: | 1477870087 |
| Last Name Of The Provider | GABALLAH |
| First Name Of The Provider | AYMAN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 E MEDICAL CENTER DR |
| Street Address 2 Of The Provider | B1 FLOOR UNIVERSITY HOSPITAL RECP C |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481095030 |
| 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 | 43 |
| Number Of Services | 922 |
| Number Of Medicare Beneficiaries | 721 |
| Total Submitted Charge Amount | 149125 |
| Total Medicare Allowed Amount | 32817.38 |
| Total Medicare Payment Amount | 24923.18 |
| Total Medicare Standardized Payment Amount | 24125.62 |
| 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 | 43 |
| Number Of Medical Services | 922 |
| Number Of Medicare Beneficiaries With Medical Services | 721 |
| Total Medical Submitted Charge Amount | 149125 |
| Total Medical Medicare Allowed Amount | 32817.38 |
| Total Medical Medicare Payment Amount | 24923.18 |
| Total Medical Medicare Standardized Payment Amount | 24125.62 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 225 |
| Number Of Beneficiaries Age 65 to 74 | 277 |
| Number Of Beneficiaries Age 75 to 84 | 166 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 340 |
| Number Of Male Beneficiaries | 381 |
| Number Of Non Hispanic White Beneficiaries | 607 |
| Number Of Black or African American Beneficiaries | 84 |
| 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 | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 530 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 191 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 59 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.6691 |