| National Provider Identifier [NPI]: | 1033185830 |
| Last Name Of The Provider | AZZAM |
| First Name Of The Provider | FOUAD |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7101 NORTHLAND CIR N |
| Street Address 2 Of The Provider | SUITE 209 |
| City Of The Provider | BROOKLYN PARK |
| Zip Code Of The Provider | 554281517 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 6866 |
| Number Of Medicare Beneficiaries | 79 |
| Total Submitted Charge Amount | 726829 |
| Total Medicare Allowed Amount | 244317.8 |
| Total Medicare Payment Amount | 194301.27 |
| Total Medicare Standardized Payment Amount | 197834.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 89 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 2528 |
| Total Drug Medicare AllowedAmount | 678.87 |
| Total Drug Medicare PaymentAmount | 647.88 |
| Total Drug Medicare Standardized Payment Amount | 647.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 6777 |
| Number Of Medicare Beneficiaries With Medical Services | 79 |
| Total Medical Submitted Charge Amount | 724301 |
| Total Medical Medicare Allowed Amount | 243638.93 |
| Total Medical Medicare Payment Amount | 193653.39 |
| Total Medical Medicare Standardized Payment Amount | 197186.57 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 43 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 75 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 16 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9327 |