| National Provider Identifier [NPI]: | 1669492120 |
| Last Name Of The Provider | MAZOUJIAN |
| First Name Of The Provider | GWEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3301 C ST |
| Street Address 2 Of The Provider | SUITE #200-E |
| City Of The Provider | SACRAMENTO |
| Zip Code Of The Provider | 958163300 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1360 |
| Number Of Medicare Beneficiaries | 659 |
| Total Submitted Charge Amount | 200272.5 |
| Total Medicare Allowed Amount | 81346.88 |
| Total Medicare Payment Amount | 63335.13 |
| Total Medicare Standardized Payment Amount | 40213.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 1360 |
| Number Of Medicare Beneficiaries With Medical Services | 659 |
| Total Medical Submitted Charge Amount | 200272.5 |
| Total Medical Medicare Allowed Amount | 81346.88 |
| Total Medical Medicare Payment Amount | 63335.13 |
| Total Medical Medicare Standardized Payment Amount | 40213.27 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 127 |
| Number Of Beneficiaries Age 65 to 74 | 327 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 518 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 423 |
| Number Of Black or African American Beneficiaries | 55 |
| Number Of AsianPacific Islander Beneficiaries | 107 |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 426 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 233 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 37 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2523 |