| National Provider Identifier [NPI]: | 1407954134 |
| Last Name Of The Provider | MANSOURI |
| First Name Of The Provider | GITI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3 BARKER AVE |
| Street Address 2 Of The Provider | FL 4 |
| City Of The Provider | WHITE PLAINS |
| Zip Code Of The Provider | 106011509 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 2761 |
| Number Of Medicare Beneficiaries | 177 |
| Total Submitted Charge Amount | 426223 |
| Total Medicare Allowed Amount | 227790.46 |
| Total Medicare Payment Amount | 177990.21 |
| Total Medicare Standardized Payment Amount | 159543.61 |
| 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 | 9 |
| Number Of Medical Services | 2761 |
| Number Of Medicare Beneficiaries With Medical Services | 177 |
| Total Medical Submitted Charge Amount | 426223 |
| Total Medical Medicare Allowed Amount | 227790.46 |
| Total Medical Medicare Payment Amount | 177990.21 |
| Total Medical Medicare Standardized Payment Amount | 159543.61 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | 52 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 101 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 88 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 27 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 150 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 72 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 3.4122 |