| National Provider Identifier [NPI]: | 1295793768 |
| Last Name Of The Provider | DAGHESTANI |
| First Name Of The Provider | GHANEM |
| 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 | 2717 MICHAEL ANGELO |
| Street Address 2 Of The Provider | SUITE 303 |
| City Of The Provider | EDINBURG |
| Zip Code Of The Provider | 785391408 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Medical Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 26419 |
| Number Of Medicare Beneficiaries | 516 |
| Total Submitted Charge Amount | 1738978.3 |
| Total Medicare Allowed Amount | 700172.32 |
| Total Medicare Payment Amount | 540103.86 |
| Total Medicare Standardized Payment Amount | 543259.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 41 |
| Number Of Drug Services | 22048 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 873377.04 |
| Total Drug Medicare AllowedAmount | 356284.07 |
| Total Drug Medicare PaymentAmount | 278696.89 |
| Total Drug Medicare Standardized Payment Amount | 278696.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 4371 |
| Number Of Medicare Beneficiaries With Medical Services | 516 |
| Total Medical Submitted Charge Amount | 865601.26 |
| Total Medical Medicare Allowed Amount | 343888.25 |
| Total Medical Medicare Payment Amount | 261406.97 |
| Total Medical Medicare Standardized Payment Amount | 264562.96 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 192 |
| Number Of Beneficiaries Age 75 to 84 | 182 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 257 |
| Number Of Male Beneficiaries | 259 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 358 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 228 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 288 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 41 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.3471 |