National Provider Identifier [NPI]: |
1790948545 |
Last Name Of The Provider |
SHAH |
First Name Of The Provider |
VIPUL |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
12728 19TH AVE SE |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
EVERETT |
Zip Code Of The Provider |
982086526 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Critical Care (Intensivists) |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
41 |
Number Of Services |
776 |
Number Of Medicare Beneficiaries |
311 |
Total Submitted Charge Amount |
366483 |
Total Medicare Allowed Amount |
124451.56 |
Total Medicare Payment Amount |
95073.21 |
Total Medicare Standardized Payment Amount |
97671.78 |
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 |
41 |
Number Of Medical Services |
776 |
Number Of Medicare Beneficiaries With Medical Services |
311 |
Total Medical Submitted Charge Amount |
366483 |
Total Medical Medicare Allowed Amount |
124451.56 |
Total Medical Medicare Payment Amount |
95073.21 |
Total Medical Medicare Standardized Payment Amount |
97671.78 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
87 |
Number Of Beneficiaries Age 65 to 74 |
117 |
Number Of Beneficiaries Age 75 to 84 |
82 |
Number Of Beneficiaries Age Greater 84 |
25 |
Number Of Female Beneficiaries |
144 |
Number Of Male Beneficiaries |
167 |
Number Of Non Hispanic White Beneficiaries |
263 |
Number Of Black or African American Beneficiaries |
12 |
Number Of AsianPacific Islander Beneficiaries |
13 |
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 |
182 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
129 |
Percent Of With Atrial Fibrillation |
28 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
54 |
Percent Of With Chronic Kidney Disease |
69 |
Percent Of With Chronic Obstructive Pulmonary Disease |
42 |
Percent Of With Depression |
41 |
Percent Of With Diabetes |
50 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
53 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
17 |
Average HCC Risk Score Of Beneficiaries |
3.0596 |