| National Provider Identifier [NPI]: | 1184633984 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | PRASHANT |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1054 MARTIN LUTHER KING DR |
| Street Address 2 Of The Provider | SUITE 224 |
| City Of The Provider | CENTRALIA |
| Zip Code Of The Provider | 628013000 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1086 |
| Number Of Medicare Beneficiaries | 571 |
| Total Submitted Charge Amount | 167819 |
| Total Medicare Allowed Amount | 72478.85 |
| Total Medicare Payment Amount | 48952.04 |
| Total Medicare Standardized Payment Amount | 51391.16 |
| 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 | 35 |
| Number Of Medical Services | 1086 |
| Number Of Medicare Beneficiaries With Medical Services | 571 |
| Total Medical Submitted Charge Amount | 167819 |
| Total Medical Medicare Allowed Amount | 72478.85 |
| Total Medical Medicare Payment Amount | 48952.04 |
| Total Medical Medicare Standardized Payment Amount | 51391.16 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 195 |
| Number Of Beneficiaries Age 75 to 84 | 166 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 303 |
| Number Of Male Beneficiaries | 268 |
| Number Of Non Hispanic White Beneficiaries | 545 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 413 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 158 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2781 |