| National Provider Identifier [NPI]: | 1811935471 |
| Last Name Of The Provider | SOUDAH |
| First Name Of The Provider | HANI |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD, PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2315 DOUGHERTY FERRY RD |
| Street Address 2 Of The Provider | SUITE 109 |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631223383 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 4398 |
| Number Of Medicare Beneficiaries | 408 |
| Total Submitted Charge Amount | 636594 |
| Total Medicare Allowed Amount | 294652.63 |
| Total Medicare Payment Amount | 218152.78 |
| Total Medicare Standardized Payment Amount | 225876.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 347 |
| Number Of Medicare Beneficiaries With Drug Services | 169 |
| Total Drug Submitted ChargeAmount | 7996 |
| Total Drug Medicare AllowedAmount | 2974.43 |
| Total Drug Medicare PaymentAmount | 2690.64 |
| Total Drug Medicare Standardized Payment Amount | 2690.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 4051 |
| Number Of Medicare Beneficiaries With Medical Services | 408 |
| Total Medical Submitted Charge Amount | 628598 |
| Total Medical Medicare Allowed Amount | 291678.2 |
| Total Medical Medicare Payment Amount | 215462.14 |
| Total Medical Medicare Standardized Payment Amount | 223185.53 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 183 |
| Number Of Beneficiaries Age 75 to 84 | 110 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 236 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 365 |
| 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 | 383 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2529 |