| National Provider Identifier [NPI]: | 1639320658 |
| Last Name Of The Provider | MAISSIAN |
| First Name Of The Provider | GEVORK |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1737 W GLENOAKS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 912011542 |
| 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 | 39 |
| Number Of Services | 5962 |
| Number Of Medicare Beneficiaries | 625 |
| Total Submitted Charge Amount | 526943.2 |
| Total Medicare Allowed Amount | 361608.08 |
| Total Medicare Payment Amount | 260588.19 |
| Total Medicare Standardized Payment Amount | 250848.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 857 |
| Number Of Medicare Beneficiaries With Drug Services | 208 |
| Total Drug Submitted ChargeAmount | 35330.2 |
| Total Drug Medicare AllowedAmount | 13061.12 |
| Total Drug Medicare PaymentAmount | 10509.68 |
| Total Drug Medicare Standardized Payment Amount | 10509.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 5105 |
| Number Of Medicare Beneficiaries With Medical Services | 625 |
| Total Medical Submitted Charge Amount | 491613 |
| Total Medical Medicare Allowed Amount | 348546.96 |
| Total Medical Medicare Payment Amount | 250078.51 |
| Total Medical Medicare Standardized Payment Amount | 240339 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 288 |
| Number Of Beneficiaries Age 75 to 84 | 234 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 369 |
| Number Of Male Beneficiaries | 256 |
| Number Of Non Hispanic White Beneficiaries | 431 |
| 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 | 125 |
| Number Of Beneficiaries With Medicare Only Entitlement | 17 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 608 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1979 |