| National Provider Identifier [NPI]: | 1295740082 |
| Last Name Of The Provider | ESAA |
| First Name Of The Provider | SHABBIR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 HIGH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILLIAMSPORT |
| Zip Code Of The Provider | 177013100 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 5215 |
| Number Of Medicare Beneficiaries | 3157 |
| Total Submitted Charge Amount | 682543 |
| Total Medicare Allowed Amount | 163437.23 |
| Total Medicare Payment Amount | 126869.45 |
| Total Medicare Standardized Payment Amount | 130673.95 |
| 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 | 168 |
| Number Of Medical Services | 5215 |
| Number Of Medicare Beneficiaries With Medical Services | 3157 |
| Total Medical Submitted Charge Amount | 682543 |
| Total Medical Medicare Allowed Amount | 163437.23 |
| Total Medical Medicare Payment Amount | 126869.45 |
| Total Medical Medicare Standardized Payment Amount | 130673.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 582 |
| Number Of Beneficiaries Age 65 to 74 | 1122 |
| Number Of Beneficiaries Age 75 to 84 | 910 |
| Number Of Beneficiaries Age Greater 84 | 543 |
| Number Of Female Beneficiaries | 1906 |
| Number Of Male Beneficiaries | 1251 |
| Number Of Non Hispanic White Beneficiaries | 3027 |
| Number Of Black or African American Beneficiaries | 87 |
| 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 | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2363 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 794 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5087 |