| National Provider Identifier [NPI]: | 1316987050 |
| Last Name Of The Provider | KHORSANDI |
| First Name Of The Provider | MOEZ |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O., FACOS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1245 WILSHIRE BLVD |
| Street Address 2 Of The Provider | SUITE 408 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900174810 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 6171 |
| Number Of Medicare Beneficiaries | 749 |
| Total Submitted Charge Amount | 1061714 |
| Total Medicare Allowed Amount | 475572.45 |
| Total Medicare Payment Amount | 371193.34 |
| Total Medicare Standardized Payment Amount | 339991.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 88 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 77250 |
| Total Drug Medicare AllowedAmount | 15346.39 |
| Total Drug Medicare PaymentAmount | 12014.24 |
| Total Drug Medicare Standardized Payment Amount | 12014.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 6083 |
| Number Of Medicare Beneficiaries With Medical Services | 749 |
| Total Medical Submitted Charge Amount | 984464 |
| Total Medical Medicare Allowed Amount | 460226.06 |
| Total Medical Medicare Payment Amount | 359179.1 |
| Total Medical Medicare Standardized Payment Amount | 327976.79 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 299 |
| Number Of Beneficiaries Age 75 to 84 | 228 |
| Number Of Beneficiaries Age Greater 84 | 126 |
| Number Of Female Beneficiaries | 198 |
| Number Of Male Beneficiaries | 551 |
| Number Of Non Hispanic White Beneficiaries | 195 |
| Number Of Black or African American Beneficiaries | 116 |
| Number Of AsianPacific Islander Beneficiaries | 103 |
| Number Of Hispanic Beneficiaries | 307 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 281 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 468 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6737 |