| National Provider Identifier [NPI]: | 1215966999 |
| Last Name Of The Provider | MORTAZAVI |
| First Name Of The Provider | KOOSHA |
| 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 | 1200 W GONZALES RD |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | OXNARD |
| Zip Code Of The Provider | 930363072 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 3016 |
| Number Of Medicare Beneficiaries | 597 |
| Total Submitted Charge Amount | 686177.8 |
| Total Medicare Allowed Amount | 436863.03 |
| Total Medicare Payment Amount | 324708.39 |
| Total Medicare Standardized Payment Amount | 312287.09 |
| 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 | 24 |
| Number Of Medical Services | 3016 |
| Number Of Medicare Beneficiaries With Medical Services | 597 |
| Total Medical Submitted Charge Amount | 686177.8 |
| Total Medical Medicare Allowed Amount | 436863.03 |
| Total Medical Medicare Payment Amount | 324708.39 |
| Total Medical Medicare Standardized Payment Amount | 312287.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 109 |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 278 |
| Number Of Male Beneficiaries | 319 |
| Number Of Non Hispanic White Beneficiaries | 253 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | 42 |
| Number Of Hispanic Beneficiaries | 265 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 347 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 250 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 70 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 3.9427 |