| National Provider Identifier [NPI]: | 1003852856 |
| Last Name Of The Provider | KHOULANI |
| First Name Of The Provider | MOHAMAD |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5080 VILLA LINDE PKWY |
| Street Address 2 Of The Provider | UNIT 4 |
| City Of The Provider | FLINT |
| Zip Code Of The Provider | 485323411 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 28763 |
| Number Of Medicare Beneficiaries | 267 |
| Total Submitted Charge Amount | 605210.93 |
| Total Medicare Allowed Amount | 410870.13 |
| Total Medicare Payment Amount | 317196.02 |
| Total Medicare Standardized Payment Amount | 320313.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 34 |
| Number Of Drug Services | 25584 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 255964.93 |
| Total Drug Medicare AllowedAmount | 175125.66 |
| Total Drug Medicare PaymentAmount | 137025.52 |
| Total Drug Medicare Standardized Payment Amount | 137025.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 3179 |
| Number Of Medicare Beneficiaries With Medical Services | 267 |
| Total Medical Submitted Charge Amount | 349246 |
| Total Medical Medicare Allowed Amount | 235744.47 |
| Total Medical Medicare Payment Amount | 180170.5 |
| Total Medical Medicare Standardized Payment Amount | 183288.41 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 85 |
| Number Of Beneficiaries Age 75 to 84 | 87 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 135 |
| Number Of Non Hispanic White Beneficiaries | 172 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 199 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 27 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.5938 |