| National Provider Identifier [NPI]: | 1356343594 |
| Last Name Of The Provider | BASSAM |
| First Name Of The Provider | DEENI |
| 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 | 8525 ROLLING RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | MANASSAS |
| Zip Code Of The Provider | 201103647 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 7087 |
| Number Of Medicare Beneficiaries | 863 |
| Total Submitted Charge Amount | 4790048.8 |
| Total Medicare Allowed Amount | 732635.86 |
| Total Medicare Payment Amount | 552512.37 |
| Total Medicare Standardized Payment Amount | 519619.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1200 |
| Number Of Medicare Beneficiaries With Drug Services | 582 |
| Total Drug Submitted ChargeAmount | 12050 |
| Total Drug Medicare AllowedAmount | 3582.34 |
| Total Drug Medicare PaymentAmount | 2765.31 |
| Total Drug Medicare Standardized Payment Amount | 2765.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 5887 |
| Number Of Medicare Beneficiaries With Medical Services | 863 |
| Total Medical Submitted Charge Amount | 4777998.8 |
| Total Medical Medicare Allowed Amount | 729053.52 |
| Total Medical Medicare Payment Amount | 549747.06 |
| Total Medical Medicare Standardized Payment Amount | 516854.12 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 402 |
| Number Of Beneficiaries Age 75 to 84 | 276 |
| Number Of Beneficiaries Age Greater 84 | 80 |
| Number Of Female Beneficiaries | 545 |
| Number Of Male Beneficiaries | 318 |
| Number Of Non Hispanic White Beneficiaries | 711 |
| Number Of Black or African American Beneficiaries | 85 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 764 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 99 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1173 |