| National Provider Identifier [NPI]: | 1700115961 |
| Last Name Of The Provider | NOURANI |
| First Name Of The Provider | BOBBY |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3209 DRYDEN DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 537043015 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 372 |
| Number Of Medicare Beneficiaries | 84 |
| Total Submitted Charge Amount | 21930.64 |
| Total Medicare Allowed Amount | 13539.36 |
| Total Medicare Payment Amount | 9872.16 |
| Total Medicare Standardized Payment Amount | 9242.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1007 |
| Total Drug Medicare AllowedAmount | 175.24 |
| Total Drug Medicare PaymentAmount | 137.65 |
| Total Drug Medicare Standardized Payment Amount | 137.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 299 |
| Number Of Medicare Beneficiaries With Medical Services | 84 |
| Total Medical Submitted Charge Amount | 20923.64 |
| Total Medical Medicare Allowed Amount | 13364.12 |
| Total Medical Medicare Payment Amount | 9734.51 |
| Total Medical Medicare Standardized Payment Amount | 9104.68 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 31 |
| Number Of Non Hispanic White Beneficiaries | 64 |
| 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 | 58 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1609 |