| National Provider Identifier [NPI]: | 1124015508 |
| Last Name Of The Provider | IBRAHIM |
| First Name Of The Provider | MIAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1214 COOLIDGE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 705032621 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 192 |
| Number Of Services | 8621 |
| Number Of Medicare Beneficiaries | 4986 |
| Total Submitted Charge Amount | 397889 |
| Total Medicare Allowed Amount | 258146.61 |
| Total Medicare Payment Amount | 198397.6 |
| Total Medicare Standardized Payment Amount | 212416.34 |
| 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 | 192 |
| Number Of Medical Services | 8621 |
| Number Of Medicare Beneficiaries With Medical Services | 4986 |
| Total Medical Submitted Charge Amount | 397889 |
| Total Medical Medicare Allowed Amount | 258146.61 |
| Total Medical Medicare Payment Amount | 198397.6 |
| Total Medical Medicare Standardized Payment Amount | 212416.34 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 983 |
| Number Of Beneficiaries Age 65 to 74 | 1839 |
| Number Of Beneficiaries Age 75 to 84 | 1529 |
| Number Of Beneficiaries Age Greater 84 | 635 |
| Number Of Female Beneficiaries | 3141 |
| Number Of Male Beneficiaries | 1845 |
| Number Of Non Hispanic White Beneficiaries | 3640 |
| Number Of Black or African American Beneficiaries | 1201 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 89 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3411 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1575 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6927 |