| National Provider Identifier [NPI]: | 1700869203 |
| Last Name Of The Provider | SHAUB |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 555 E HARDY ST |
| Street Address 2 Of The Provider | CENTINELA HOSPITAL MEDICAL CENTER |
| City Of The Provider | INGLEWOOD |
| Zip Code Of The Provider | 90301 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 200 |
| Number Of Services | 8348 |
| Number Of Medicare Beneficiaries | 3721 |
| Total Submitted Charge Amount | 1078973.97 |
| Total Medicare Allowed Amount | 259000 |
| Total Medicare Payment Amount | 186047.53 |
| Total Medicare Standardized Payment Amount | 176913.2 |
| 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 | 200 |
| Number Of Medical Services | 8348 |
| Number Of Medicare Beneficiaries With Medical Services | 3721 |
| Total Medical Submitted Charge Amount | 1078973.97 |
| Total Medical Medicare Allowed Amount | 259000 |
| Total Medical Medicare Payment Amount | 186047.53 |
| Total Medical Medicare Standardized Payment Amount | 176913.2 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 761 |
| Number Of Beneficiaries Age 65 to 74 | 1195 |
| Number Of Beneficiaries Age 75 to 84 | 1057 |
| Number Of Beneficiaries Age Greater 84 | 708 |
| Number Of Female Beneficiaries | 2297 |
| Number Of Male Beneficiaries | 1424 |
| Number Of Non Hispanic White Beneficiaries | 1116 |
| Number Of Black or African American Beneficiaries | 1929 |
| Number Of AsianPacific Islander Beneficiaries | 123 |
| Number Of Hispanic Beneficiaries | 496 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1622 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2099 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.6003 |