| National Provider Identifier [NPI]: | 1659349561 |
| Last Name Of The Provider | MUSALLAM |
| First Name Of The Provider | JACOB |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10401 W THUNDERBIRD BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SUN CITY |
| Zip Code Of The Provider | 853513004 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 151 |
| Number Of Services | 4113 |
| Number Of Medicare Beneficiaries | 3037 |
| Total Submitted Charge Amount | 416238 |
| Total Medicare Allowed Amount | 130905.2 |
| Total Medicare Payment Amount | 94099.93 |
| Total Medicare Standardized Payment Amount | 95815.18 |
| 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 | 151 |
| Number Of Medical Services | 4113 |
| Number Of Medicare Beneficiaries With Medical Services | 3037 |
| Total Medical Submitted Charge Amount | 416238 |
| Total Medical Medicare Allowed Amount | 130905.2 |
| Total Medical Medicare Payment Amount | 94099.93 |
| Total Medical Medicare Standardized Payment Amount | 95815.18 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 131 |
| Number Of Beneficiaries Age 65 to 74 | 1033 |
| Number Of Beneficiaries Age 75 to 84 | 1163 |
| Number Of Beneficiaries Age Greater 84 | 710 |
| Number Of Female Beneficiaries | 1738 |
| Number Of Male Beneficiaries | 1299 |
| Number Of Non Hispanic White Beneficiaries | 2836 |
| Number Of Black or African American Beneficiaries | 56 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 79 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2871 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 166 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5872 |