| National Provider Identifier [NPI]: | 1356363253 |
| Last Name Of The Provider | GHANTOUS |
| First Name Of The Provider | VICTOR |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 735 FITZWATERTOWN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILLOW GROVE |
| Zip Code Of The Provider | 190901332 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 1541 |
| Number Of Medicare Beneficiaries | 661 |
| Total Submitted Charge Amount | 385571 |
| Total Medicare Allowed Amount | 190751.8 |
| Total Medicare Payment Amount | 145241.55 |
| Total Medicare Standardized Payment Amount | 137832.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1541 |
| Number Of Medicare Beneficiaries With Medical Services | 661 |
| Total Medical Submitted Charge Amount | 385571 |
| Total Medical Medicare Allowed Amount | 190751.8 |
| Total Medical Medicare Payment Amount | 145241.55 |
| Total Medical Medicare Standardized Payment Amount | 137832.2 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 156 |
| Number Of Beneficiaries Age 65 to 74 | 206 |
| Number Of Beneficiaries Age 75 to 84 | 180 |
| Number Of Beneficiaries Age Greater 84 | 119 |
| Number Of Female Beneficiaries | 303 |
| Number Of Male Beneficiaries | 358 |
| Number Of Non Hispanic White Beneficiaries | 437 |
| Number Of Black or African American Beneficiaries | 175 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 487 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 174 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 57 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 4.9452 |