| National Provider Identifier [NPI]: | 1700819836 |
| Last Name Of The Provider | EZUDDIN |
| First Name Of The Provider | SHABBIR |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1611 NW 12TH AVE |
| Street Address 2 Of The Provider | BOX 016960 (M851) |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331361005 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 1299 |
| Number Of Medicare Beneficiaries | 1057 |
| Total Submitted Charge Amount | 351617 |
| Total Medicare Allowed Amount | 96317.54 |
| Total Medicare Payment Amount | 72867.89 |
| Total Medicare Standardized Payment Amount | 67198.25 |
| 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 | 52 |
| Number Of Medical Services | 1299 |
| Number Of Medicare Beneficiaries With Medical Services | 1057 |
| Total Medical Submitted Charge Amount | 351617 |
| Total Medical Medicare Allowed Amount | 96317.54 |
| Total Medical Medicare Payment Amount | 72867.89 |
| Total Medical Medicare Standardized Payment Amount | 67198.25 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 236 |
| Number Of Beneficiaries Age 65 to 74 | 458 |
| Number Of Beneficiaries Age 75 to 84 | 279 |
| Number Of Beneficiaries Age Greater 84 | 84 |
| Number Of Female Beneficiaries | 548 |
| Number Of Male Beneficiaries | 509 |
| Number Of Non Hispanic White Beneficiaries | 381 |
| Number Of Black or African American Beneficiaries | 178 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 472 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 482 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 575 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 40 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.6709 |