| National Provider Identifier [NPI]: | 1295810547 |
| Last Name Of The Provider | MOIDUDDIN |
| First Name Of The Provider | SHAKIR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7530 W COLLEGE DR |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | PALOS HEIGHTS |
| Zip Code Of The Provider | 60463 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 2397 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 268137 |
| Total Medicare Allowed Amount | 170413.35 |
| Total Medicare Payment Amount | 127577.06 |
| Total Medicare Standardized Payment Amount | 119594.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 120 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 7000 |
| Total Drug Medicare AllowedAmount | 1891.4 |
| Total Drug Medicare PaymentAmount | 1820.27 |
| Total Drug Medicare Standardized Payment Amount | 1820.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 2277 |
| Number Of Medicare Beneficiaries With Medical Services | 221 |
| Total Medical Submitted Charge Amount | 261137 |
| Total Medical Medicare Allowed Amount | 168521.95 |
| Total Medical Medicare Payment Amount | 125756.79 |
| Total Medical Medicare Standardized Payment Amount | 117774.53 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 77 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 93 |
| Number Of Non Hispanic White Beneficiaries | 195 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 204 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4056 |