| National Provider Identifier [NPI]: | 1891001400 |
| Last Name Of The Provider | MORI |
| First Name Of The Provider | SHAHRAM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD. PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2501 N ORANGE AVE |
| Street Address 2 Of The Provider | SUITE 581 |
| City Of The Provider | ORLANDO |
| Zip Code Of The Provider | 328044603 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Medical Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 1769 |
| Number Of Medicare Beneficiaries | 70 |
| Total Submitted Charge Amount | 116855 |
| Total Medicare Allowed Amount | 44225.52 |
| Total Medicare Payment Amount | 34494.23 |
| Total Medicare Standardized Payment Amount | 34094.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 1313 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 5403 |
| Total Drug Medicare AllowedAmount | 1411.43 |
| Total Drug Medicare PaymentAmount | 1106.57 |
| Total Drug Medicare Standardized Payment Amount | 1106.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 456 |
| Number Of Medicare Beneficiaries With Medical Services | 70 |
| Total Medical Submitted Charge Amount | 111452 |
| Total Medical Medicare Allowed Amount | 42814.09 |
| Total Medical Medicare Payment Amount | 33387.66 |
| Total Medical Medicare Standardized Payment Amount | 32987.53 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 34 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 41 |
| Number Of Black or African American Beneficiaries | 11 |
| 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 | 54 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.9407 |