| National Provider Identifier [NPI]: | 1669540423 |
| Last Name Of The Provider | GHANEM |
| First Name Of The Provider | GHAZI |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1450 E A ST |
| Street Address 2 Of The Provider | STE 1 |
| City Of The Provider | CASPER |
| Zip Code Of The Provider | 826012239 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 255941 |
| Number Of Medicare Beneficiaries | 642 |
| Total Submitted Charge Amount | 1377950.7 |
| Total Medicare Allowed Amount | 547197.47 |
| Total Medicare Payment Amount | 422480.05 |
| Total Medicare Standardized Payment Amount | 426702.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 23 |
| Number Of Drug Services | 251880 |
| Number Of Medicare Beneficiaries With Drug Services | 122 |
| Total Drug Submitted ChargeAmount | 460606.7 |
| Total Drug Medicare AllowedAmount | 195589.95 |
| Total Drug Medicare PaymentAmount | 153661.37 |
| Total Drug Medicare Standardized Payment Amount | 153661.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 4061 |
| Number Of Medicare Beneficiaries With Medical Services | 642 |
| Total Medical Submitted Charge Amount | 917344 |
| Total Medical Medicare Allowed Amount | 351607.52 |
| Total Medical Medicare Payment Amount | 268818.68 |
| Total Medical Medicare Standardized Payment Amount | 273041.54 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 170 |
| Number Of Beneficiaries Age 65 to 74 | 209 |
| Number Of Beneficiaries Age 75 to 84 | 200 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 339 |
| Number Of Male Beneficiaries | 303 |
| Number Of Non Hispanic White Beneficiaries | 588 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 460 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 182 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 2.0589 |