| National Provider Identifier [NPI]: | 1356527360 |
| Last Name Of The Provider | TEHRANI |
| First Name Of The Provider | MAHTAB |
| 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 | 4301 W MARKHAM ST |
| Street Address 2 Of The Provider | ROOM S4/05 |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722057101 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1938 |
| Number Of Medicare Beneficiaries | 588 |
| Total Submitted Charge Amount | 400049 |
| Total Medicare Allowed Amount | 82938.54 |
| Total Medicare Payment Amount | 64157.83 |
| Total Medicare Standardized Payment Amount | 49489.48 |
| 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 | 24 |
| Number Of Medical Services | 1938 |
| Number Of Medicare Beneficiaries With Medical Services | 588 |
| Total Medical Submitted Charge Amount | 400049 |
| Total Medical Medicare Allowed Amount | 82938.54 |
| Total Medical Medicare Payment Amount | 64157.83 |
| Total Medical Medicare Standardized Payment Amount | 49489.48 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 288 |
| Number Of Beneficiaries Age 75 to 84 | 180 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 339 |
| Number Of Male Beneficiaries | 249 |
| Number Of Non Hispanic White Beneficiaries | 413 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | 72 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 491 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.4008 |