| National Provider Identifier [NPI]: | 1083726319 |
| Last Name Of The Provider | SAFARI |
| First Name Of The Provider | EHSAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 430 PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | 110 |
| City Of The Provider | GLEN ELLYN |
| Zip Code Of The Provider | 601374464 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 141 |
| Number Of Services | 40179 |
| Number Of Medicare Beneficiaries | 2491 |
| Total Submitted Charge Amount | 2065316 |
| Total Medicare Allowed Amount | 592269.27 |
| Total Medicare Payment Amount | 442236.65 |
| Total Medicare Standardized Payment Amount | 425381.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 36768 |
| Number Of Medicare Beneficiaries With Drug Services | 431 |
| Total Drug Submitted ChargeAmount | 73796 |
| Total Drug Medicare AllowedAmount | 7782.53 |
| Total Drug Medicare PaymentAmount | 6081.3 |
| Total Drug Medicare Standardized Payment Amount | 6081.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 3411 |
| Number Of Medicare Beneficiaries With Medical Services | 2491 |
| Total Medical Submitted Charge Amount | 1991520 |
| Total Medical Medicare Allowed Amount | 584486.74 |
| Total Medical Medicare Payment Amount | 436155.35 |
| Total Medical Medicare Standardized Payment Amount | 419300.63 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 153 |
| Number Of Beneficiaries Age 65 to 74 | 1284 |
| Number Of Beneficiaries Age 75 to 84 | 739 |
| Number Of Beneficiaries Age Greater 84 | 315 |
| Number Of Female Beneficiaries | 1430 |
| Number Of Male Beneficiaries | 1061 |
| Number Of Non Hispanic White Beneficiaries | 2218 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | 78 |
| Number Of Hispanic Beneficiaries | 85 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2322 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 169 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.153 |