| National Provider Identifier [NPI]: | 1811217037 |
| Last Name Of The Provider | KHANIFAR |
| First Name Of The Provider | ELHAM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2801 ATLANTIC AVE |
| Street Address 2 Of The Provider | LBMMC DEPARTMENT OF PATHOLOGY |
| City Of The Provider | LONG BEACH |
| Zip Code Of The Provider | 908061701 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 915 |
| Number Of Medicare Beneficiaries | 315 |
| Total Submitted Charge Amount | 216539 |
| Total Medicare Allowed Amount | 47854.06 |
| Total Medicare Payment Amount | 37241.15 |
| Total Medicare Standardized Payment Amount | 27646.64 |
| 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 | 25 |
| Number Of Medical Services | 915 |
| Number Of Medicare Beneficiaries With Medical Services | 315 |
| Total Medical Submitted Charge Amount | 216539 |
| Total Medical Medicare Allowed Amount | 47854.06 |
| Total Medical Medicare Payment Amount | 37241.15 |
| Total Medical Medicare Standardized Payment Amount | 27646.64 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 155 |
| Number Of Non Hispanic White Beneficiaries | 152 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 109 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 164 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7628 |