| National Provider Identifier [NPI]: | 1407064421 |
| Last Name Of The Provider | MOSHIRI |
| First Name Of The Provider | MARIAM |
| 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 | 1959 NE PACIFIC ST BOX 357115 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SEATTLE |
| Zip Code Of The Provider | 981957115 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 1082 |
| Number Of Medicare Beneficiaries | 743 |
| Total Submitted Charge Amount | 172258.36 |
| Total Medicare Allowed Amount | 55808.81 |
| Total Medicare Payment Amount | 41577.81 |
| Total Medicare Standardized Payment Amount | 40662.32 |
| 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 | 59 |
| Number Of Medical Services | 1082 |
| Number Of Medicare Beneficiaries With Medical Services | 743 |
| Total Medical Submitted Charge Amount | 172258.36 |
| Total Medical Medicare Allowed Amount | 55808.81 |
| Total Medical Medicare Payment Amount | 41577.81 |
| Total Medical Medicare Standardized Payment Amount | 40662.32 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 289 |
| Number Of Beneficiaries Age 65 to 74 | 316 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 364 |
| Number Of Male Beneficiaries | 379 |
| Number Of Non Hispanic White Beneficiaries | 555 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | 69 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 455 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 288 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 2.4051 |