| National Provider Identifier [NPI]: | 1619072600 |
| Last Name Of The Provider | FANOUS |
| First Name Of The Provider | BASEM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14124 FOOTHILL BLVD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | SYLMAR |
| Zip Code Of The Provider | 91342 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 4542 |
| Number Of Medicare Beneficiaries | 688 |
| Total Submitted Charge Amount | 453488 |
| Total Medicare Allowed Amount | 327213.61 |
| Total Medicare Payment Amount | 233658.28 |
| Total Medicare Standardized Payment Amount | 214391.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 330 |
| Number Of Medicare Beneficiaries With Drug Services | 238 |
| Total Drug Submitted ChargeAmount | 13572 |
| Total Drug Medicare AllowedAmount | 4405.25 |
| Total Drug Medicare PaymentAmount | 4261.93 |
| Total Drug Medicare Standardized Payment Amount | 4261.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 77 |
| Number Of Medical Services | 4212 |
| Number Of Medicare Beneficiaries With Medical Services | 688 |
| Total Medical Submitted Charge Amount | 439916 |
| Total Medical Medicare Allowed Amount | 322808.36 |
| Total Medical Medicare Payment Amount | 229396.35 |
| Total Medical Medicare Standardized Payment Amount | 210129.18 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 284 |
| Number Of Beneficiaries Age 65 to 74 | 187 |
| Number Of Beneficiaries Age 75 to 84 | 156 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 397 |
| Number Of Male Beneficiaries | 291 |
| Number Of Non Hispanic White Beneficiaries | 240 |
| Number Of Black or African American Beneficiaries | 64 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 346 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 594 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5765 |