| National Provider Identifier [NPI]: | 1003922162 |
| Last Name Of The Provider | SHAMBAN |
| First Name Of The Provider | AVA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2021 SANTA MONICA BLVD |
| Street Address 2 Of The Provider | SUITE 600E |
| City Of The Provider | SANTA MONICA |
| Zip Code Of The Provider | 90404 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 513 |
| Number Of Medicare Beneficiaries | 123 |
| Total Submitted Charge Amount | 54126.5 |
| Total Medicare Allowed Amount | 37149.13 |
| Total Medicare Payment Amount | 26826.97 |
| Total Medicare Standardized Payment Amount | 23243.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 49 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 8375 |
| Total Drug Medicare AllowedAmount | 5508.02 |
| Total Drug Medicare PaymentAmount | 4312.57 |
| Total Drug Medicare Standardized Payment Amount | 4312.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 464 |
| Number Of Medicare Beneficiaries With Medical Services | 123 |
| Total Medical Submitted Charge Amount | 45751.5 |
| Total Medical Medicare Allowed Amount | 31641.11 |
| Total Medical Medicare Payment Amount | 22514.4 |
| Total Medical Medicare Standardized Payment Amount | 18930.76 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 95 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 123 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7564 |