| National Provider Identifier [NPI]: | 1114183993 |
| Last Name Of The Provider | GOLSHAN |
| First Name Of The Provider | ALI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10724 WILSHIRE BLVD |
| Street Address 2 Of The Provider | UNIT 1404 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900244460 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 208 |
| Number Of Services | 16500 |
| Number Of Medicare Beneficiaries | 2524 |
| Total Submitted Charge Amount | 2460221.7 |
| Total Medicare Allowed Amount | 697972.4 |
| Total Medicare Payment Amount | 542695.93 |
| Total Medicare Standardized Payment Amount | 484120.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 11260 |
| Number Of Medicare Beneficiaries With Drug Services | 156 |
| Total Drug Submitted ChargeAmount | 11325.7 |
| Total Drug Medicare AllowedAmount | 2361.67 |
| Total Drug Medicare PaymentAmount | 1851.56 |
| Total Drug Medicare Standardized Payment Amount | 1851.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 206 |
| Number Of Medical Services | 5240 |
| Number Of Medicare Beneficiaries With Medical Services | 2524 |
| Total Medical Submitted Charge Amount | 2448896 |
| Total Medical Medicare Allowed Amount | 695610.73 |
| Total Medical Medicare Payment Amount | 540844.37 |
| Total Medical Medicare Standardized Payment Amount | 482268.72 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 445 |
| Number Of Beneficiaries Age 65 to 74 | 715 |
| Number Of Beneficiaries Age 75 to 84 | 805 |
| Number Of Beneficiaries Age Greater 84 | 559 |
| Number Of Female Beneficiaries | 1377 |
| Number Of Male Beneficiaries | 1147 |
| Number Of Non Hispanic White Beneficiaries | 989 |
| Number Of Black or African American Beneficiaries | 432 |
| Number Of AsianPacific Islander Beneficiaries | 422 |
| Number Of Hispanic Beneficiaries | 624 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 562 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1962 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 37 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 62 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 3.3796 |