| National Provider Identifier [NPI]: | 1942203971 |
| Last Name Of The Provider | SHAMSHAM |
| First Name Of The Provider | FADI |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4115 S. WATER TOWER PLACE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MT. VERNON |
| Zip Code Of The Provider | 62864 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 6244 |
| Number Of Medicare Beneficiaries | 1769 |
| Total Submitted Charge Amount | 2314754.5 |
| Total Medicare Allowed Amount | 648220.77 |
| Total Medicare Payment Amount | 495900.32 |
| Total Medicare Standardized Payment Amount | 522078.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 205 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 28900 |
| Total Drug Medicare AllowedAmount | 10817.68 |
| Total Drug Medicare PaymentAmount | 8350.25 |
| Total Drug Medicare Standardized Payment Amount | 8350.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 6039 |
| Number Of Medicare Beneficiaries With Medical Services | 1769 |
| Total Medical Submitted Charge Amount | 2285854.5 |
| Total Medical Medicare Allowed Amount | 637403.09 |
| Total Medical Medicare Payment Amount | 487550.07 |
| Total Medical Medicare Standardized Payment Amount | 513727.83 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 256 |
| Number Of Beneficiaries Age 65 to 74 | 626 |
| Number Of Beneficiaries Age 75 to 84 | 574 |
| Number Of Beneficiaries Age Greater 84 | 313 |
| Number Of Female Beneficiaries | 938 |
| Number Of Male Beneficiaries | 831 |
| Number Of Non Hispanic White Beneficiaries | 1700 |
| Number Of Black or African American Beneficiaries | 49 |
| 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 | 1309 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 460 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6848 |