| National Provider Identifier [NPI]: | 1275536773 |
| Last Name Of The Provider | MAHDAVI |
| First Name Of The Provider | KHOSROW |
| 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 | 520 SUPERIOR AVE |
| Street Address 2 Of The Provider | #315 |
| City Of The Provider | NEWPORT BEACH |
| Zip Code Of The Provider | 926633637 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 13203 |
| Number Of Medicare Beneficiaries | 654 |
| Total Submitted Charge Amount | 1635818 |
| Total Medicare Allowed Amount | 684528.58 |
| Total Medicare Payment Amount | 521413.55 |
| Total Medicare Standardized Payment Amount | 476272.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 7494 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 551852 |
| Total Drug Medicare AllowedAmount | 62240.78 |
| Total Drug Medicare PaymentAmount | 48789.33 |
| Total Drug Medicare Standardized Payment Amount | 48789.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 5709 |
| Number Of Medicare Beneficiaries With Medical Services | 654 |
| Total Medical Submitted Charge Amount | 1083966 |
| Total Medical Medicare Allowed Amount | 622287.8 |
| Total Medical Medicare Payment Amount | 472624.22 |
| Total Medical Medicare Standardized Payment Amount | 427482.96 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 254 |
| Number Of Beneficiaries Age 75 to 84 | 267 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 337 |
| Number Of Male Beneficiaries | 317 |
| Number Of Non Hispanic White Beneficiaries | 558 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 57 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 520 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 134 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 39 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 2.0234 |