| National Provider Identifier [NPI]: | 1649349408 |
| Last Name Of The Provider | HAJIBRAHIM |
| First Name Of The Provider | OMAR |
| 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 | 289 IRELAND AVE |
| Street Address 2 Of The Provider | IRELAND ARMY COMMUNITY HOSPITAL, DEPT OF RADIOLOGY |
| City Of The Provider | FORT KNOX |
| Zip Code Of The Provider | 401215111 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 3480 |
| Number Of Medicare Beneficiaries | 2285 |
| Total Submitted Charge Amount | 307390 |
| Total Medicare Allowed Amount | 95876.93 |
| Total Medicare Payment Amount | 72400.16 |
| Total Medicare Standardized Payment Amount | 76368.94 |
| 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 | 167 |
| Number Of Medical Services | 3480 |
| Number Of Medicare Beneficiaries With Medical Services | 2285 |
| Total Medical Submitted Charge Amount | 307390 |
| Total Medical Medicare Allowed Amount | 95876.93 |
| Total Medical Medicare Payment Amount | 72400.16 |
| Total Medical Medicare Standardized Payment Amount | 76368.94 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 670 |
| Number Of Beneficiaries Age 65 to 74 | 738 |
| Number Of Beneficiaries Age 75 to 84 | 568 |
| Number Of Beneficiaries Age Greater 84 | 309 |
| Number Of Female Beneficiaries | 1450 |
| Number Of Male Beneficiaries | 835 |
| Number Of Non Hispanic White Beneficiaries | 2153 |
| Number Of Black or African American Beneficiaries | 107 |
| 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 | 1312 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 973 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7407 |