| National Provider Identifier [NPI]: | 1124031802 |
| Last Name Of The Provider | KHORSAND |
| First Name Of The Provider | JILA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 825 CHALKSTONE AVE |
| Street Address 2 Of The Provider | ROGER WILLIAMS MEDICAL CENTER/PATHOLOGY DEPT |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029084728 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1230 |
| Number Of Medicare Beneficiaries | 484 |
| Total Submitted Charge Amount | 86641 |
| Total Medicare Allowed Amount | 28098.68 |
| Total Medicare Payment Amount | 21488.89 |
| Total Medicare Standardized Payment Amount | 18834.16 |
| 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 | 25 |
| Number Of Medical Services | 1230 |
| Number Of Medicare Beneficiaries With Medical Services | 484 |
| Total Medical Submitted Charge Amount | 86641 |
| Total Medical Medicare Allowed Amount | 28098.68 |
| Total Medical Medicare Payment Amount | 21488.89 |
| Total Medical Medicare Standardized Payment Amount | 18834.16 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 161 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 288 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | 435 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 337 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 147 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.7874 |