| National Provider Identifier [NPI]: | 1346341575 |
| Last Name Of The Provider | BANAFSHE |
| First Name Of The Provider | PAYMON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6222 W MANCHESTER AVE |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900453801 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 86 |
| Number Of Services | 11709 |
| Number Of Medicare Beneficiaries | 809 |
| Total Submitted Charge Amount | 1182950 |
| Total Medicare Allowed Amount | 751119.51 |
| Total Medicare Payment Amount | 601341.21 |
| Total Medicare Standardized Payment Amount | 572893.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 197 |
| Number Of Medicare Beneficiaries With Drug Services | 117 |
| Total Drug Submitted ChargeAmount | 11080 |
| Total Drug Medicare AllowedAmount | 6842.22 |
| Total Drug Medicare PaymentAmount | 6674.05 |
| Total Drug Medicare Standardized Payment Amount | 6674.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 11512 |
| Number Of Medicare Beneficiaries With Medical Services | 809 |
| Total Medical Submitted Charge Amount | 1171870 |
| Total Medical Medicare Allowed Amount | 744277.29 |
| Total Medical Medicare Payment Amount | 594667.16 |
| Total Medical Medicare Standardized Payment Amount | 566219.12 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 180 |
| Number Of Beneficiaries Age 65 to 74 | 276 |
| Number Of Beneficiaries Age 75 to 84 | 222 |
| Number Of Beneficiaries Age Greater 84 | 131 |
| Number Of Female Beneficiaries | 491 |
| Number Of Male Beneficiaries | 318 |
| Number Of Non Hispanic White Beneficiaries | 191 |
| Number Of Black or African American Beneficiaries | 434 |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 147 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 279 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 530 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.8183 |