| National Provider Identifier [NPI]: | 1407058530 |
| Last Name Of The Provider | GOROUHI |
| First Name Of The Provider | FARIBORZ |
| 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 | 2705 HOSPITAL DR |
| Street Address 2 Of The Provider | SUITE 401 |
| City Of The Provider | VICTORIA |
| Zip Code Of The Provider | 779015775 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 31708 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 775611.08 |
| Total Medicare Allowed Amount | 410878.56 |
| Total Medicare Payment Amount | 320775.8 |
| Total Medicare Standardized Payment Amount | 324460.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 36 |
| Number Of Drug Services | 29652 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 459687.86 |
| Total Drug Medicare AllowedAmount | 263439.62 |
| Total Drug Medicare PaymentAmount | 206164.92 |
| Total Drug Medicare Standardized Payment Amount | 206164.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 2056 |
| Number Of Medicare Beneficiaries With Medical Services | 157 |
| Total Medical Submitted Charge Amount | 315923.22 |
| Total Medical Medicare Allowed Amount | 147438.94 |
| Total Medical Medicare Payment Amount | 114610.88 |
| Total Medical Medicare Standardized Payment Amount | 118295.12 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 73 |
| Number Of Male Beneficiaries | 84 |
| Number Of Non Hispanic White Beneficiaries | 119 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 124 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 44 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.0739 |