| National Provider Identifier [NPI]: | 1306812870 |
| Last Name Of The Provider | MORTAZAVI |
| First Name Of The Provider | ALA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2028 OPITZ BLVD. |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | WOODBRIDGE |
| Zip Code Of The Provider | 22191 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 6927 |
| Number Of Medicare Beneficiaries | 1424 |
| Total Submitted Charge Amount | 1459768 |
| Total Medicare Allowed Amount | 693886.27 |
| Total Medicare Payment Amount | 532229.84 |
| Total Medicare Standardized Payment Amount | 548436.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 232 |
| Number Of Medicare Beneficiaries With Drug Services | 208 |
| Total Drug Submitted ChargeAmount | 9404 |
| Total Drug Medicare AllowedAmount | 5776.88 |
| Total Drug Medicare PaymentAmount | 5656.18 |
| Total Drug Medicare Standardized Payment Amount | 5656.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 6695 |
| Number Of Medicare Beneficiaries With Medical Services | 1424 |
| Total Medical Submitted Charge Amount | 1450364 |
| Total Medical Medicare Allowed Amount | 688109.39 |
| Total Medical Medicare Payment Amount | 526573.66 |
| Total Medical Medicare Standardized Payment Amount | 542780.42 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 217 |
| Number Of Beneficiaries Age 65 to 74 | 557 |
| Number Of Beneficiaries Age 75 to 84 | 441 |
| Number Of Beneficiaries Age Greater 84 | 209 |
| Number Of Female Beneficiaries | 846 |
| Number Of Male Beneficiaries | 578 |
| Number Of Non Hispanic White Beneficiaries | 897 |
| Number Of Black or African American Beneficiaries | 353 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 89 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1120 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 304 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 39 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 46 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9198 |