| National Provider Identifier [NPI]: | 1114162948 |
| Last Name Of The Provider | KIZILBASH |
| First Name Of The Provider | MOHAMMAD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1340 CHARLES ST |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | ROCKFORD |
| Zip Code Of The Provider | 611042200 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 5353 |
| Number Of Medicare Beneficiaries | 3106 |
| Total Submitted Charge Amount | 821902 |
| Total Medicare Allowed Amount | 232985.6 |
| Total Medicare Payment Amount | 170008.21 |
| Total Medicare Standardized Payment Amount | 175556.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 10597 |
| Total Drug Medicare AllowedAmount | 1648.03 |
| Total Drug Medicare PaymentAmount | 1248.6 |
| Total Drug Medicare Standardized Payment Amount | 1248.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 5317 |
| Number Of Medicare Beneficiaries With Medical Services | 3106 |
| Total Medical Submitted Charge Amount | 811305 |
| Total Medical Medicare Allowed Amount | 231337.57 |
| Total Medical Medicare Payment Amount | 168759.61 |
| Total Medical Medicare Standardized Payment Amount | 174308.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 595 |
| Number Of Beneficiaries Age 65 to 74 | 1071 |
| Number Of Beneficiaries Age 75 to 84 | 866 |
| Number Of Beneficiaries Age Greater 84 | 574 |
| Number Of Female Beneficiaries | 1661 |
| Number Of Male Beneficiaries | 1445 |
| Number Of Non Hispanic White Beneficiaries | 2684 |
| Number Of Black or African American Beneficiaries | 223 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 143 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2266 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 840 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.736 |