| National Provider Identifier [NPI]: | 1346549219 |
| Last Name Of The Provider | KOTOB |
| First Name Of The Provider | FAYEZ |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D., M.B.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5050 VILLA LINDE PKWY STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | FLINT |
| Zip Code Of The Provider | 485323436 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 1651 |
| Number Of Medicare Beneficiaries | 202 |
| Total Submitted Charge Amount | 812806 |
| Total Medicare Allowed Amount | 109742.63 |
| Total Medicare Payment Amount | 81252.16 |
| Total Medicare Standardized Payment Amount | 81107.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 685 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 18589 |
| Total Drug Medicare AllowedAmount | 777.89 |
| Total Drug Medicare PaymentAmount | 587.89 |
| Total Drug Medicare Standardized Payment Amount | 587.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 966 |
| Number Of Medicare Beneficiaries With Medical Services | 202 |
| Total Medical Submitted Charge Amount | 794217 |
| Total Medical Medicare Allowed Amount | 108964.74 |
| Total Medical Medicare Payment Amount | 80664.27 |
| Total Medical Medicare Standardized Payment Amount | 80519.51 |
| Average Age Of Beneficiaries | 56 |
| Number Of Beneficiaries Age Less65 | 144 |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 112 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | 141 |
| 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 | 77 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5181 |