| National Provider Identifier [NPI]: | 1629269972 |
| Last Name Of The Provider | BASANI |
| First Name Of The Provider | SHAILESH |
| 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 | 2409 MITCHELL RD |
| Street Address 2 Of The Provider | BEDFORD |
| City Of The Provider | BEDFORD |
| Zip Code Of The Provider | 474214731 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 1231 |
| Number Of Medicare Beneficiaries | 247 |
| Total Submitted Charge Amount | 175963 |
| Total Medicare Allowed Amount | 103133.56 |
| Total Medicare Payment Amount | 75745.34 |
| Total Medicare Standardized Payment Amount | 78588.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 184 |
| Number Of Medicare Beneficiaries With Drug Services | 65 |
| Total Drug Submitted ChargeAmount | 12188 |
| Total Drug Medicare AllowedAmount | 6438.33 |
| Total Drug Medicare PaymentAmount | 6093.23 |
| Total Drug Medicare Standardized Payment Amount | 6093.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 1047 |
| Number Of Medicare Beneficiaries With Medical Services | 247 |
| Total Medical Submitted Charge Amount | 163775 |
| Total Medical Medicare Allowed Amount | 96695.23 |
| Total Medical Medicare Payment Amount | 69652.11 |
| Total Medical Medicare Standardized Payment Amount | 72495.71 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 69 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 139 |
| Number Of Male Beneficiaries | 108 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 159 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3009 |