| National Provider Identifier [NPI]: | 1316101918 |
| Last Name Of The Provider | BANGOURA |
| First Name Of The Provider | FANNY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1925 W ORANGE GROVE RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 857041143 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 3564 |
| Number Of Medicare Beneficiaries | 226 |
| Total Submitted Charge Amount | 247702.15 |
| Total Medicare Allowed Amount | 132591.5 |
| Total Medicare Payment Amount | 102506.91 |
| Total Medicare Standardized Payment Amount | 104790.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 853 |
| Number Of Medicare Beneficiaries With Drug Services | 79 |
| Total Drug Submitted ChargeAmount | 10212 |
| Total Drug Medicare AllowedAmount | 5959.29 |
| Total Drug Medicare PaymentAmount | 5769.72 |
| Total Drug Medicare Standardized Payment Amount | 5769.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 167 |
| Number Of Medical Services | 2711 |
| Number Of Medicare Beneficiaries With Medical Services | 226 |
| Total Medical Submitted Charge Amount | 237490.15 |
| Total Medical Medicare Allowed Amount | 126632.21 |
| Total Medical Medicare Payment Amount | 96737.19 |
| Total Medical Medicare Standardized Payment Amount | 99020.31 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 133 |
| Number Of Beneficiaries Age 75 to 84 | 46 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 184 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | 202 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7591 |