| National Provider Identifier [NPI]: | 1780636167 |
| Last Name Of The Provider | HAFEZ |
| First Name Of The Provider | MOHAMED |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3102 E. HIGHLAND AVENUE |
| Street Address 2 Of The Provider | MEDICAL STAFF OFFICE |
| City Of The Provider | PATTON |
| Zip Code Of The Provider | 92369 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Unknown Physician Specialty Code |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 821 |
| Number Of Medicare Beneficiaries | 124 |
| Total Submitted Charge Amount | 56927.63 |
| Total Medicare Allowed Amount | 37854.02 |
| Total Medicare Payment Amount | 26274.01 |
| Total Medicare Standardized Payment Amount | 23045.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 225 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 9766 |
| Total Drug Medicare AllowedAmount | 206.2 |
| Total Drug Medicare PaymentAmount | 157.59 |
| Total Drug Medicare Standardized Payment Amount | 157.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 596 |
| Number Of Medicare Beneficiaries With Medical Services | 124 |
| Total Medical Submitted Charge Amount | 47161.63 |
| Total Medical Medicare Allowed Amount | 37647.82 |
| Total Medical Medicare Payment Amount | 26116.42 |
| Total Medical Medicare Standardized Payment Amount | 22887.47 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 46 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 79 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 48 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.161 |