Active NPI 1376573295 Individual Practitioner Male Practitioner

Dr. Talha Shamim , MD

Internal Medicine • Ocoee, FL

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Dr. Talha Shamim, MD is a certified Internal Medicine practicing in Ocoee, FL. With approximately 33 years of clinical experience since completing medical education in 1993, Dr. Shamim delivers high-quality medical care to the local community at 1144 KELTON AVE STE 1009.

Dr. Shamim maintains professional affiliations with Adventhealth Bond Clinic, Inc., Bond Clinic Pa and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include subsequent hospital care with moderate levelof medical decision making, if using time, at least, hospital discharge day management, more than, initial hospital care with straightforward or low-level medical decision making, if using time, at least. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1144 Kelton Ave Ste 1009

Ocoee, FL 347613175

Telephone 4075538030

Fax 4075538035

Associated Practice Facility / Clinic

🏢 Poinciana Internal Medicine Pa Facility NPI 1063841567

Medicare Profile & Education

Medical School

Other

Graduation Year

1993

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Ocoee, FL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

33 Yrs +13.4 yrs vs City Avg

City Avg: 19.6 Yrs

State Avg: 26.5 Yrs

Regional Practice Density

50 Specialists

Practicing in Ocoee, FL (10650 Statewide)

Telehealth Adoption Rate

20.0% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

49.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Shamim (33 Years) 33 Yrs

Ocoee Specialty Average (19.6 Years) 19.6 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	1,854	604	$140.89	$77.03
99239 Hospital discharge day management, more than 30 minutes	233	226	$202.26	$111.19
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	122	116	$282.94	$128.16
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	53	53	$341.32	$169.26
99238 Hospital discharge day management, 30 minutes or less	26	26	$146.49	$78.90

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	809	274	$138.38	$78.50
99213 Established patient office or other outpatient visit, typically 15 minutes	389	220	$167.58	$88.49
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	258	177	$243.21	$125.16
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	215	215	$239.49	$125.15
99239 Hospital discharge day management, more than 30 minutes	191	177	$204.71	$113.02
99231 Follow-up hospital inpatient care per day, typically 15 minutes	178	68	$67.78	$49.80
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	72	71	$282.94	$129.69
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	34	34	$383.58	$172.23
99238 Hospital discharge day management, 30 minutes or less	25	25	$148.58	$79.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	935	370	$131.14	$90.01
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	762	215	$147.64	$70.99
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	140	140	$208.07	$128.51
99239 Hospital discharge day management, more than 30 minutes	120	109	$217.52	$103.91
99231 Follow-up hospital inpatient care per day, typically 15 minutes	112	63	$67.78	$38.80
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	51	49	$414.02	$197.57
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	49	31	$212.76	$101.50
99225 Subsequent observation care, typically 25 minutes per day	43	30	$148.32	$70.61
99238 Hospital discharge day management, 30 minutes or less	33	32	$148.58	$71.06
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	31	31	$279.17	$134.69
G0442 Annual alcohol misuse screening, 5 to 15 minutes	30	30	$37.33	$18.37
99497 Advance care planning, first 30 minutes	30	30	$156.90	$84.96
G0444 Annual depression screening, 5 to 15 minutes	29	29	$35.66	$18.04
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	26	24	$150.15	$126.24
99217 Hospital observation care on day of discharge	22	22	$147.88	$70.73
G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes	21	21	$52.81	$26.66
99442 Telephone medical discussion with physician, 11-20 minutes	17	15	$180.00	$89.46
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	15	15	$106.66	$52.33
99219 Hospital observation care, typically 50 minutes	13	13	$277.50	$132.07
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$251.67	$168.14

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,360	419	$181.31	$90.89
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	891	117	$81.00	$40.65
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	564	193	$147.83	$72.18
99454 Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days	342	106	$119.00	$59.48
G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes	298	298	$53.86	$26.88
G0444 Annual depression screening, 5 to 15 minutes	297	297	$36.91	$18.25
99497 Advance care planning, first 30 minutes	297	297	$171.36	$85.15
G0442 Annual alcohol misuse screening, 5 to 15 minutes	295	295	$37.57	$18.25
99458 Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; each additional 20 minute	289	92	$81.00	$40.65
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	286	286	$262.96	$131.83
99457 Management using the results of remote vital sign monitoring per calendar month, first 20 minutes	275	99	$99.98	$49.83
99231 Follow-up hospital inpatient care per day, typically 15 minutes	203	94	$67.78	$38.52
99453 Remote monitoring of physiologic parameters, initial set-up and patient education on use of equipment	104	104	$36.00	$18.19
99239 Hospital discharge day management, more than 30 minutes	102	95	$214.70	$106.23
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	93	78	$239.59	$124.09
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	71	70	$379.72	$201.13
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	62	62	$337.81	$166.73
98968 Telephone medical discussion provided by nonphysician professional, 21-30 minutes	40	37	$80.00	$39.49
98967 Telephone medical discussion provided by nonphysician professional, 11-20 minutes	39	37	$54.00	$26.99
G0447 Face-to-face behavioral counseling for obesity, 15 minutes	34	33	$53.03	$26.88
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	32	26	$208.12	$103.66
99225 Subsequent observation care, typically 25 minutes per day	26	23	$148.53	$72.18
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	26	25	$105.70	$52.42
99217 Hospital observation care on day of discharge	22	22	$147.55	$72.10
99220 Hospital observation care, typically 70 minutes	20	20	$365.71	$182.61
93000 Routine ekg using at least 12 leads including interpretation and report	19	18	$30.00	$14.80
99238 Hospital discharge day management, 30 minutes or less	18	18	$145.37	$72.10
99224 Subsequent observation care, typically 15 minutes per day	17	14	$81.38	$38.85
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	13	13	$269.47	$136.97

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	1,992	217	$82.00	$41.75
99213 Established patient office or other outpatient visit, typically 15 minutes	1,579	455	$147.32	$74.73
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	729	233	$148.40	$73.30
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	224	224	$225.88	$114.50
99454 Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days	121	24	$120.00	$59.05
99225 Subsequent observation care, typically 25 minutes per day	118	72	$149.00	$73.51
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	106	89	$211.03	$108.18
99239 Hospital discharge day management, more than 30 minutes	102	100	$191.40	$107.92
G0444 Annual depression screening, 5 to 15 minutes	82	82	$35.00	$17.92
G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes	80	80	$51.00	$26.63
99497 Advance care planning, first 30 minutes	79	79	$180.00	$86.10
G0442 Annual alcohol misuse screening, 5 to 15 minutes	77	77	$50.00	$17.92
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	56	53	$312.54	$205.71
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	55	49	$326.00	$165.65
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	46	29	$196.26	$105.57
99457 Management using the results of remote vital sign monitoring per calendar month, first 20 minutes	44	24	$100.00	$50.38
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	42	36	$141.72	$53.07
99217 Hospital observation care on day of discharge	41	39	$140.56	$73.28
99458 Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; each additional 20 minute	36	19	$82.00	$41.71
99220 Hospital observation care, typically 70 minutes	35	35	$313.50	$188.25
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)	27	24	$123.07	$62.34
99453 Remote monitoring of physiologic parameters, initial set-up and patient education on use of equipment	24	24	$36.00	$17.68
99231 Follow-up hospital inpatient care per day, typically 15 minutes	24	18	$67.78	$40.35
G0447 Face-to-face behavioral counseling for obesity, 15 minutes	20	20	$43.00	$26.63
93000 Routine ekg using at least 12 leads including interpretation and report	18	16	$33.00	$17.01
98968 Telephone medical discussion provided by nonphysician professional, 21-30 minutes	16	16	$80.00	$39.99
99238 Hospital discharge day management, 30 minutes or less	13	12	$140.32	$74.29

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	2,098	263	$82.55	$41.12
99213 Established patient office or other outpatient visit, typically 15 minutes	1,794	527	$145.85	$73.34
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	1,247	329	$128.77	$73.01
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)	234	232	$124.99	$62.01
99239 Hospital discharge day management, more than 30 minutes	212	188	$191.40	$106.93
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	203	155	$212.22	$107.00
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	199	199	$229.03	$114.26
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	108	108	$326.04	$164.10
99225 Subsequent observation care, typically 25 minutes per day	98	63	$111.98	$73.36
85610 Blood test, clotting time	81	11	$10.00	$4.28
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	77	76	$224.56	$137.78
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	61	57	$151.95	$52.51
99217 Hospital observation care on day of discharge	46	45	$140.56	$73.02
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	39	37	$312.54	$203.04
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	26	22	$196.26	$104.33
99220 Hospital observation care, typically 70 minutes	26	25	$313.50	$180.02
99238 Hospital discharge day management, 30 minutes or less	19	19	$140.32	$73.02
93000 Routine ekg using at least 12 leads including interpretation and report	19	19	$33.00	$16.82
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	14	14	$88.00	$44.48
99219 Hospital observation care, typically 50 minutes	12	12	$223.14	$136.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,751	536	$145.00	$71.90
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	1,059	323	$112.09	$73.28
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	328	228	$215.00	$106.24
99239 Hospital discharge day management, more than 30 minutes	205	179	$193.82	$107.83
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	193	193	$230.00	$115.14
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	112	105	$329.07	$204.32
99225 Subsequent observation care, typically 25 minutes per day	87	64	$99.98	$73.48
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	72	72	$330.00	$164.43
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	61	15	$40.00	$20.01
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	61	54	$139.31	$53.15
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	61	15	$5.00	$1.96
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	56	11	$40.00	$21.03
99220 Hospital observation care, typically 70 minutes	34	34	$313.50	$187.40
99217 Hospital observation care on day of discharge	34	34	$140.56	$73.28
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)	30	30	$125.00	$62.71
93000 Routine ekg using at least 12 leads including interpretation and report	27	26	$35.00	$16.78
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	22	18	$99.12	$41.05
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	20	$85.10	$43.34
99238 Hospital discharge day management, 30 minutes or less	14	14	$140.32	$73.36
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	12	$224.56	$137.97
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	11	11	$330.00	$164.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,534	503	$215.00	$102.26
95004 Test for allergy using allergenic extract	1,151	15	$17.00	$6.33
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	1,015	383	$116.79	$69.91
99213 Established patient office or other outpatient visit, typically 15 minutes	665	379	$146.00	$69.47
95024 Injection of allergenic extracts into skin for immediate reaction analysis	404	12	$19.00	$7.31
99239 Hospital discharge day management, more than 30 minutes	216	189	$199.38	$104.16
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	153	132	$358.37	$197.81
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	110	110	$331.16	$157.06
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	88	12	$10.00	$2.89
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	88	12	$50.00	$23.92
85610 Blood test, clotting time	65	12	$10.14	$5.13
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	65	60	$132.68	$51.43
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	60	60	$232.73	$109.43
99225 Subsequent observation care, typically 25 minutes per day	47	42	$99.98	$71.46
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	29	27	$87.00	$41.34
93000 Routine ekg using at least 12 leads including interpretation and report	27	26	$34.00	$16.15
99220 Hospital observation care, typically 70 minutes	27	26	$313.50	$176.79
99217 Hospital observation care on day of discharge	27	27	$140.56	$71.33
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	26	26	$344.00	$161.84
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	25	25	$300.08	$134.18
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	24	16	$82.92	$39.15
99221 Initial hospital inpatient care per day, typically 30 minutes	15	15	$292.51	$99.86
G0396 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes	13	13	$72.00	$35.08
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	12	11	$201.84	$101.95

Medical Specialties & State Licenses

CMS Verified: 2023-10-31

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License FL ME102917

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Hospitalist

NUCC Taxonomy Code: 208M00000X

State License FL ME102917

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

003171300 (FL)

Hospital & Practice Group Affiliations

Adventhealth Bond Clinic, Inc.

500 E Central Ave, Winter Haven, FL 338803053

Phone: 8632931191

Bond Clinic Pa

500 E Central Ave, Winter Haven, FL 338803053

Phone: 8632931191

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events

📍

Updated Practice Location October 31, 2023

Registered at 1144 KELTON AVE STE 1009, OCOEE, FL 347613175 (Tel: 4075538030)

📍

Updated Business Mailing Address October 31, 2023

Registered at 1144 KELTON AVE STE 1009, OCOEE, FL 347613175 (Tel: 4075538030)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 31, 2023

Hospitalist (License #ME102917 in FL)

📍

Updated Practice Location August 10, 2022

Registered at 339 CYPRESS PKWY STE 250, KISSIMMEE, FL 347593315 (Tel: 3212501850)

📍

Updated Business Mailing Address August 10, 2022

Registered at 601 S HARBOUR ISLAND BLVD STE 200, TAMPA, FL 336025925 (Tel: 7273223439)

📍

Updated Business Mailing Address July 03, 2019

Registered at 339 CYPRESS PKWY, STE 250, KISSIMMEE, FL 347593315 (Tel: 8632931191)

✅

NPI Profile Active September 12, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location September 12, 2012

Registered at 500 E CENTRAL AVE, WINTER HAVEN, FL 338803053 (Tel: 8632931191)

📍

Updated Business Mailing Address September 12, 2012

Registered at 500 E CENTRAL AVE, WINTER HAVEN, FL 338803053 (Tel: 8632931191)

👤

Provider Name / Credentials Updated September 12, 2012

Recorded as TALHA SHAMIM, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 12, 2012

Internal Medicine (License #ME102917 in FL)

🟢

Initial NPI Registration & Enumeration July 04, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1376573295

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 04, 2006

Last Update: October 31, 2023

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1144 Kelton Ave Ste 1009

Ocoee, FL 347613175

Phone: 4075538030

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.