| National Provider Identifier [NPI]: | 1245470004 |
| Last Name Of The Provider | DAVOODI |
| First Name Of The Provider | ARDESHIR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3600 JOSEPH SIEWICK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRFAX |
| Zip Code Of The Provider | 220331709 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 928 |
| Number Of Medicare Beneficiaries | 428 |
| Total Submitted Charge Amount | 122374.5 |
| Total Medicare Allowed Amount | 92150.28 |
| Total Medicare Payment Amount | 64835.05 |
| Total Medicare Standardized Payment Amount | 60660.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 1625 |
| Total Drug Medicare AllowedAmount | 509.55 |
| Total Drug Medicare PaymentAmount | 495.54 |
| Total Drug Medicare Standardized Payment Amount | 495.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 891 |
| Number Of Medicare Beneficiaries With Medical Services | 427 |
| Total Medical Submitted Charge Amount | 120749.5 |
| Total Medical Medicare Allowed Amount | 91640.73 |
| Total Medical Medicare Payment Amount | 64339.51 |
| Total Medical Medicare Standardized Payment Amount | 60165 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 180 |
| Number Of Beneficiaries Age 75 to 84 | 118 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 251 |
| Number Of Male Beneficiaries | 177 |
| Number Of Non Hispanic White Beneficiaries | 57 |
| Number Of Black or African American Beneficiaries | 342 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 328 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 100 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.4884 |