| National Provider Identifier [NPI]: | 1417999335 |
| Last Name Of The Provider | KHAN |
| First Name Of The Provider | EHTISHAM |
| 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 | 8371 HIGHWAY 72 W |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 357589505 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1161 |
| Number Of Medicare Beneficiaries | 277 |
| Total Submitted Charge Amount | 189126 |
| Total Medicare Allowed Amount | 95601.64 |
| Total Medicare Payment Amount | 72350.64 |
| Total Medicare Standardized Payment Amount | 78724.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 96 |
| Number Of Medicare Beneficiaries With Drug Services | 61 |
| Total Drug Submitted ChargeAmount | 4772 |
| Total Drug Medicare AllowedAmount | 3049.38 |
| Total Drug Medicare PaymentAmount | 2962.75 |
| Total Drug Medicare Standardized Payment Amount | 2962.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 1065 |
| Number Of Medicare Beneficiaries With Medical Services | 277 |
| Total Medical Submitted Charge Amount | 184354 |
| Total Medical Medicare Allowed Amount | 92552.26 |
| Total Medical Medicare Payment Amount | 69387.89 |
| Total Medical Medicare Standardized Payment Amount | 75761.6 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 117 |
| Number Of Beneficiaries Age 75 to 84 | 83 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 125 |
| Number Of Non Hispanic White Beneficiaries | 234 |
| 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 | 231 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0857 |