| National Provider Identifier [NPI]: | 1194770461 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | SIDDHARTH |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2038 SPRINGDALE LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | TARRANT |
| Zip Code Of The Provider | 352172028 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 2972 |
| Number Of Medicare Beneficiaries | 205 |
| Total Submitted Charge Amount | 90048 |
| Total Medicare Allowed Amount | 67558.86 |
| Total Medicare Payment Amount | 45848.67 |
| Total Medicare Standardized Payment Amount | 50221.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 1273 |
| Number Of Medicare Beneficiaries With Drug Services | 123 |
| Total Drug Submitted ChargeAmount | 10444 |
| Total Drug Medicare AllowedAmount | 2533.41 |
| Total Drug Medicare PaymentAmount | 2137.68 |
| Total Drug Medicare Standardized Payment Amount | 2137.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 1699 |
| Number Of Medicare Beneficiaries With Medical Services | 205 |
| Total Medical Submitted Charge Amount | 79604 |
| Total Medical Medicare Allowed Amount | 65025.45 |
| Total Medical Medicare Payment Amount | 43710.99 |
| Total Medical Medicare Standardized Payment Amount | 48083.63 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 115 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | 143 |
| Number Of Black or African American Beneficiaries | |
| 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 | 156 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0689 |