| National Provider Identifier [NPI]: | 1699717124 |
| Last Name Of The Provider | SHAMLOU |
| First Name Of The Provider | K |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1673 MASON AVE |
| Street Address 2 Of The Provider | SUITE# 305 |
| City Of The Provider | DAYTONA BEACH |
| Zip Code Of The Provider | 321175515 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 216 |
| Number Of Services | 25244.8 |
| Number Of Medicare Beneficiaries | 3345 |
| Total Submitted Charge Amount | 2396062.92 |
| Total Medicare Allowed Amount | 864488.28 |
| Total Medicare Payment Amount | 683132.83 |
| Total Medicare Standardized Payment Amount | 696671.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 19414.5 |
| Number Of Medicare Beneficiaries With Drug Services | 314 |
| Total Drug Submitted ChargeAmount | 29123.68 |
| Total Drug Medicare AllowedAmount | 6762.08 |
| Total Drug Medicare PaymentAmount | 5275.15 |
| Total Drug Medicare Standardized Payment Amount | 5275.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 206 |
| Number Of Medical Services | 5830.3 |
| Number Of Medicare Beneficiaries With Medical Services | 3342 |
| Total Medical Submitted Charge Amount | 2366939.24 |
| Total Medical Medicare Allowed Amount | 857726.2 |
| Total Medical Medicare Payment Amount | 677857.68 |
| Total Medical Medicare Standardized Payment Amount | 691396.84 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 447 |
| Number Of Beneficiaries Age 65 to 74 | 1502 |
| Number Of Beneficiaries Age 75 to 84 | 1001 |
| Number Of Beneficiaries Age Greater 84 | 395 |
| Number Of Female Beneficiaries | 2268 |
| Number Of Male Beneficiaries | 1077 |
| Number Of Non Hispanic White Beneficiaries | 2865 |
| Number Of Black or African American Beneficiaries | 295 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 118 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2835 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 510 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3272 |