| National Provider Identifier [NPI]: | 1922100320 |
| Last Name Of The Provider | SHAHATTO |
| First Name Of The Provider | NAEL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 399 E HIGHLAND AVE |
| Street Address 2 Of The Provider | STE 309 |
| City Of The Provider | SAN BERNARDINO |
| Zip Code Of The Provider | 92404 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 1607 |
| Number Of Medicare Beneficiaries | 193 |
| Total Submitted Charge Amount | 205390 |
| Total Medicare Allowed Amount | 162792.82 |
| Total Medicare Payment Amount | 127512.87 |
| Total Medicare Standardized Payment Amount | 124731.33 |
| 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 | 10 |
| Number Of Medical Services | 1607 |
| Number Of Medicare Beneficiaries With Medical Services | 193 |
| Total Medical Submitted Charge Amount | 205390 |
| Total Medical Medicare Allowed Amount | 162792.82 |
| Total Medical Medicare Payment Amount | 127512.87 |
| Total Medical Medicare Standardized Payment Amount | 124731.33 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 105 |
| Number Of Non Hispanic White Beneficiaries | 98 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 65 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 128 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 65 |
| Percent Of With Chronic Kidney Disease | 70 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 69 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 3.7605 |