Nishit Shah M.D.

Gender: M
Medical School: Other
Graduation Year: 2013
Primary Specialty: Internal Medicine

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted17
Total Provider Services1146
Total Medicare beneficiaries receiving the provider services526
The total charges that the provider submitted for all services$255,772.00
The Medicare allowed amount for all provider services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$144,624.99
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$108,869.57
Total Medicare Standardized Payment Amount$112,368.57
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File0
Total drug services, as defined from the Medicare Part B Drug ASP File0
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.0
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$0.00
The Medicare allowed amount for drug services, as defined from the Medicare Part B Drug ASP File. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$0.00
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item drug services, as defined from the Medicare Part B Drug ASP File.$0.00
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item drug service , as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care.$0.00
Total number of HCPCS codes associated with medical (non-ASP) services17
Total medical (non-ASP) services1146
Total Medicare beneficiaries receiving medical (non-ASP) services526
The total charges that the provider submitted for medical services (non-ASP)$255,772.00
The Medicare allowed amount for medical (non-ASP) services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$144,624.99
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$108,869.57
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item medical (non-ASP) service , as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care$112,368.57
Average age of beneficiaries74
Number of beneficiaries under the age of 6585
Number of beneficiaries between the ages of 65 and 74175
Number of beneficiaries between the ages of 75 and 84164
Number of beneficiaries over the age of 84102
Number of Female beneficiaries292
Number of Male Beneficiaries234
Number of Non-Hispanic White Beneficiaries497
Number of Black or African American Beneficiaries13
Number of Asian Pacific Islander Beneficiaries0
Number of American Indian/Alaska Native Beneficiaries0
Number of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar year363
Number of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefits163
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation29%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia21%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma9%
Percent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer13%
Percent of beneficiaries meeting the CCW chronic condition algorithm for heart failure45%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease56%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease43%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression41%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes46%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia71%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension75%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease52%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis9%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis55%
Percent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders9%
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke15%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries2.3154

Source: data.cms.gov

Nishit Shah M.D.'s 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Hospital observation care discharge 118 111 118 $71.9 $125.0 $56.02 223%
Hospital observation care typically 50 minutes 25 25 25 $134.69 $235.0 $102.24 230%
Hospital observation care typically 70 minutes per day 95 92 95 $184.14 $321.0 $135.54 237%
Initial hospital inpatient care, typically 50 minutes per day 13 13 13 $135.79 $240.0 $91.93 261%
Initial hospital inpatient care, typically 70 minutes per day 159 150 159 $200.98 $352.0 $146.84 240%
Subsequent hospital inpatient care, typically 25 minutes per day 87 62 87 $71.56 $125.0 $55.75 224%
Subsequent hospital inpatient care, typically 35 minutes per day 331 178 331 $103.48 $180.0 $79.59 226%
Hospital observation or inpatient care high severity, 55 minutes per day 27 27 27 $216.15 $378.0 $147.03 257%
Hospital discharge day management, more than 30 minutes 221 202 221 $106.1 $185.0 $82.62 224%
Critical care delivery critically ill or injured patient, first 30-74 minutes 42 38 42 $222.59 $470.0 $174.41 269%
Source: 2017 Provider CMS Charge Data