| National Provider Identifier [NPI]: | 1407018021 |
| Last Name Of The Provider | DAFTARIAN |
| First Name Of The Provider | ALI |
| 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 | 3841 SAGEBRIAR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BRYAN |
| Zip Code Of The Provider | 778026107 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 7420 |
| Number Of Medicare Beneficiaries | 850 |
| Total Submitted Charge Amount | 2206257.25 |
| Total Medicare Allowed Amount | 592556.71 |
| Total Medicare Payment Amount | 442597.89 |
| Total Medicare Standardized Payment Amount | 438201.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 3324 |
| Number Of Medicare Beneficiaries With Drug Services | 416 |
| Total Drug Submitted ChargeAmount | 73426 |
| Total Drug Medicare AllowedAmount | 7836.99 |
| Total Drug Medicare PaymentAmount | 6114.47 |
| Total Drug Medicare Standardized Payment Amount | 6114.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 4096 |
| Number Of Medicare Beneficiaries With Medical Services | 850 |
| Total Medical Submitted Charge Amount | 2132831.25 |
| Total Medical Medicare Allowed Amount | 584719.72 |
| Total Medical Medicare Payment Amount | 436483.42 |
| Total Medical Medicare Standardized Payment Amount | 432086.65 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 154 |
| Number Of Beneficiaries Age 65 to 74 | 346 |
| Number Of Beneficiaries Age 75 to 84 | 271 |
| Number Of Beneficiaries Age Greater 84 | 79 |
| Number Of Female Beneficiaries | 535 |
| Number Of Male Beneficiaries | 315 |
| Number Of Non Hispanic White Beneficiaries | 733 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 730 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2308 |