| National Provider Identifier [NPI]: | 1891728564 |
| Last Name Of The Provider | KHOURY |
| First Name Of The Provider | MAROON |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3010 TRENWEST DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINSTON SALEM |
| Zip Code Of The Provider | 271033208 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 185 |
| Number Of Services | 12366 |
| Number Of Medicare Beneficiaries | 6151 |
| Total Submitted Charge Amount | 1039382 |
| Total Medicare Allowed Amount | 319964.91 |
| Total Medicare Payment Amount | 242429.63 |
| Total Medicare Standardized Payment Amount | 251354.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 185 |
| Number Of Medical Services | 12366 |
| Number Of Medicare Beneficiaries With Medical Services | 6151 |
| Total Medical Submitted Charge Amount | 1039382 |
| Total Medical Medicare Allowed Amount | 319964.91 |
| Total Medical Medicare Payment Amount | 242429.63 |
| Total Medical Medicare Standardized Payment Amount | 251354.03 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1659 |
| Number Of Beneficiaries Age 65 to 74 | 1878 |
| Number Of Beneficiaries Age 75 to 84 | 1563 |
| Number Of Beneficiaries Age Greater 84 | 1051 |
| Number Of Female Beneficiaries | 3818 |
| Number Of Male Beneficiaries | 2333 |
| Number Of Non Hispanic White Beneficiaries | 4958 |
| Number Of Black or African American Beneficiaries | 1057 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3828 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2323 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7309 |