| National Provider Identifier [NPI]: | 1487836748 |
| Last Name Of The Provider | IZADMANESH |
| First Name Of The Provider | FAEZEH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9010 W CHEYENNE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891298932 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 1162 |
| Number Of Medicare Beneficiaries | 568 |
| Total Submitted Charge Amount | 201925 |
| Total Medicare Allowed Amount | 77682.59 |
| Total Medicare Payment Amount | 51470.42 |
| Total Medicare Standardized Payment Amount | 50522.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 188 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 12950 |
| Total Drug Medicare AllowedAmount | 4109.05 |
| Total Drug Medicare PaymentAmount | 3516.9 |
| Total Drug Medicare Standardized Payment Amount | 3516.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 974 |
| Number Of Medicare Beneficiaries With Medical Services | 568 |
| Total Medical Submitted Charge Amount | 188975 |
| Total Medical Medicare Allowed Amount | 73573.54 |
| Total Medical Medicare Payment Amount | 47953.52 |
| Total Medical Medicare Standardized Payment Amount | 47006.08 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 304 |
| Number Of Beneficiaries Age 75 to 84 | 179 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 381 |
| Number Of Male Beneficiaries | 187 |
| Number Of Non Hispanic White Beneficiaries | 527 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 536 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8334 |