| National Provider Identifier [NPI]: | 1861472250 |
| Last Name Of The Provider | HOSSEINI-DEHKORDI |
| First Name Of The Provider | MARYAM |
| 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 | 6440 NICOLLET AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHFIELD |
| Zip Code Of The Provider | 554231613 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 977 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 88917 |
| Total Medicare Allowed Amount | 40242.59 |
| Total Medicare Payment Amount | 29082.76 |
| Total Medicare Standardized Payment Amount | 30055.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 2320 |
| Total Drug Medicare AllowedAmount | 1285.17 |
| Total Drug Medicare PaymentAmount | 1187.2 |
| Total Drug Medicare Standardized Payment Amount | 1187.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 923 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 86597 |
| Total Medical Medicare Allowed Amount | 38957.42 |
| Total Medical Medicare Payment Amount | 27895.56 |
| Total Medical Medicare Standardized Payment Amount | 28868.19 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | 153 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 135 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 17 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0082 |