| National Provider Identifier [NPI]: | 1629073994 |
| Last Name Of The Provider | GOUDARZI |
| First Name Of The Provider | BEHNAM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2028 OPITZ BLVD STE B |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBRIDGE |
| Zip Code Of The Provider | 221913326 |
| 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 | 43 |
| Number Of Services | 5224 |
| Number Of Medicare Beneficiaries | 1265 |
| Total Submitted Charge Amount | 1621612 |
| Total Medicare Allowed Amount | 833669.46 |
| Total Medicare Payment Amount | 638267.86 |
| Total Medicare Standardized Payment Amount | 662562.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 164 |
| Number Of Medicare Beneficiaries With Drug Services | 147 |
| Total Drug Submitted ChargeAmount | 7167 |
| Total Drug Medicare AllowedAmount | 4581.86 |
| Total Drug Medicare PaymentAmount | 4488.32 |
| Total Drug Medicare Standardized Payment Amount | 4488.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 5060 |
| Number Of Medicare Beneficiaries With Medical Services | 1265 |
| Total Medical Submitted Charge Amount | 1614445 |
| Total Medical Medicare Allowed Amount | 829087.6 |
| Total Medical Medicare Payment Amount | 633779.54 |
| Total Medical Medicare Standardized Payment Amount | 658074.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 203 |
| Number Of Beneficiaries Age 65 to 74 | 488 |
| Number Of Beneficiaries Age 75 to 84 | 390 |
| Number Of Beneficiaries Age Greater 84 | 184 |
| Number Of Female Beneficiaries | 753 |
| Number Of Male Beneficiaries | 512 |
| Number Of Non Hispanic White Beneficiaries | 780 |
| Number Of Black or African American Beneficiaries | 342 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 75 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 986 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 279 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 33 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9523 |