| National Provider Identifier [NPI]: | 1043264690 |
| Last Name Of The Provider | BANISADRE |
| First Name Of The Provider | MUSSA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1325 MELROSE AVE |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 953505508 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 93460 |
| Number Of Medicare Beneficiaries | 478 |
| Total Submitted Charge Amount | 2418796.05 |
| Total Medicare Allowed Amount | 1242797.14 |
| Total Medicare Payment Amount | 962368.06 |
| Total Medicare Standardized Payment Amount | 948905.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 48 |
| Number Of Drug Services | 89535 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 1759989.05 |
| Total Drug Medicare AllowedAmount | 962624.67 |
| Total Drug Medicare PaymentAmount | 750301.58 |
| Total Drug Medicare Standardized Payment Amount | 750301.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 3925 |
| Number Of Medicare Beneficiaries With Medical Services | 478 |
| Total Medical Submitted Charge Amount | 658807 |
| Total Medical Medicare Allowed Amount | 280172.47 |
| Total Medical Medicare Payment Amount | 212066.48 |
| Total Medical Medicare Standardized Payment Amount | 198604.11 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 182 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 325 |
| Number Of Male Beneficiaries | 153 |
| Number Of Non Hispanic White Beneficiaries | 436 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 443 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 58 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.6826 |