| National Provider Identifier [NPI]: | 1588649560 |
| Last Name Of The Provider | MANSOUR |
| First Name Of The Provider | MOUSSA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 55 FRUIT ST |
| Street Address 2 Of The Provider | ELECTROPHYSIOLOGY LAB ARRHYTHMIA SERVICE GRB 109 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021142621 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Electrophysiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 3304 |
| Number Of Medicare Beneficiaries | 1511 |
| Total Submitted Charge Amount | 1366298 |
| Total Medicare Allowed Amount | 368803.78 |
| Total Medicare Payment Amount | 280788.29 |
| Total Medicare Standardized Payment Amount | 271054.16 |
| 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 | 57 |
| Number Of Medical Services | 3304 |
| Number Of Medicare Beneficiaries With Medical Services | 1511 |
| Total Medical Submitted Charge Amount | 1366298 |
| Total Medical Medicare Allowed Amount | 368803.78 |
| Total Medical Medicare Payment Amount | 280788.29 |
| Total Medical Medicare Standardized Payment Amount | 271054.16 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 522 |
| Number Of Beneficiaries Age 75 to 84 | 556 |
| Number Of Beneficiaries Age Greater 84 | 334 |
| Number Of Female Beneficiaries | 573 |
| Number Of Male Beneficiaries | 938 |
| Number Of Non Hispanic White Beneficiaries | 1384 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1290 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 221 |
| Percent Of With Atrial Fibrillation | 59 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 55 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7096 |