| National Provider Identifier [NPI]: | 1619034725 |
| Last Name Of The Provider | DERDERIAN |
| First Name Of The Provider | HRAK |
| 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 | 6838 NEWCASTLE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | RESEDA |
| Zip Code Of The Provider | 913354616 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 16751 |
| Number Of Medicare Beneficiaries | 1159 |
| Total Submitted Charge Amount | 1040361 |
| Total Medicare Allowed Amount | 393785.46 |
| Total Medicare Payment Amount | 302893.91 |
| Total Medicare Standardized Payment Amount | 294508.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 14688 |
| Number Of Medicare Beneficiaries With Drug Services | 160 |
| Total Drug Submitted ChargeAmount | 267150 |
| Total Drug Medicare AllowedAmount | 183315.25 |
| Total Drug Medicare PaymentAmount | 143541.74 |
| Total Drug Medicare Standardized Payment Amount | 143541.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 2063 |
| Number Of Medicare Beneficiaries With Medical Services | 1159 |
| Total Medical Submitted Charge Amount | 773211 |
| Total Medical Medicare Allowed Amount | 210470.21 |
| Total Medical Medicare Payment Amount | 159352.17 |
| Total Medical Medicare Standardized Payment Amount | 150966.89 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 304 |
| Number Of Beneficiaries Age 65 to 74 | 325 |
| Number Of Beneficiaries Age 75 to 84 | 323 |
| Number Of Beneficiaries Age Greater 84 | 207 |
| Number Of Female Beneficiaries | 640 |
| Number Of Male Beneficiaries | 519 |
| Number Of Non Hispanic White Beneficiaries | 587 |
| Number Of Black or African American Beneficiaries | 130 |
| Number Of AsianPacific Islander Beneficiaries | 148 |
| Number Of Hispanic Beneficiaries | 237 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 83 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1076 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 40 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 26 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.5908 |