| National Provider Identifier [NPI]: | 1649240755 |
| Last Name Of The Provider | MOSTAFAVI |
| First Name Of The Provider | MOHAMMAD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3640 MAIN ST |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 011071145 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 4324 |
| Number Of Medicare Beneficiaries | 920 |
| Total Submitted Charge Amount | 924682.8 |
| Total Medicare Allowed Amount | 330311.62 |
| Total Medicare Payment Amount | 246963.43 |
| Total Medicare Standardized Payment Amount | 241567.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 367 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 98959 |
| Total Drug Medicare AllowedAmount | 29436.05 |
| Total Drug Medicare PaymentAmount | 22876.86 |
| Total Drug Medicare Standardized Payment Amount | 22876.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 3957 |
| Number Of Medicare Beneficiaries With Medical Services | 920 |
| Total Medical Submitted Charge Amount | 825723.8 |
| Total Medical Medicare Allowed Amount | 300875.57 |
| Total Medical Medicare Payment Amount | 224086.57 |
| Total Medical Medicare Standardized Payment Amount | 218691.08 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 350 |
| Number Of Beneficiaries Age 75 to 84 | 283 |
| Number Of Beneficiaries Age Greater 84 | 155 |
| Number Of Female Beneficiaries | 220 |
| Number Of Male Beneficiaries | 700 |
| Number Of Non Hispanic White Beneficiaries | 780 |
| Number Of Black or African American Beneficiaries | 56 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 729 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 191 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.222 |