| National Provider Identifier [NPI]: | 1790902328 |
| Last Name Of The Provider | MOGANNAM |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 N STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900331029 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 115 |
| Number Of Services | 11410 |
| Number Of Medicare Beneficiaries | 1430 |
| Total Submitted Charge Amount | 1953582.01 |
| Total Medicare Allowed Amount | 1011963.19 |
| Total Medicare Payment Amount | 781651.06 |
| Total Medicare Standardized Payment Amount | 673102.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2759 |
| Number Of Medicare Beneficiaries With Drug Services | 253 |
| Total Drug Submitted ChargeAmount | 398349.72 |
| Total Drug Medicare AllowedAmount | 205939.21 |
| Total Drug Medicare PaymentAmount | 160968.97 |
| Total Drug Medicare Standardized Payment Amount | 160968.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 111 |
| Number Of Medical Services | 8651 |
| Number Of Medicare Beneficiaries With Medical Services | 1430 |
| Total Medical Submitted Charge Amount | 1555232.29 |
| Total Medical Medicare Allowed Amount | 806023.98 |
| Total Medical Medicare Payment Amount | 620682.09 |
| Total Medical Medicare Standardized Payment Amount | 512133.81 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 333 |
| Number Of Beneficiaries Age 65 to 74 | 432 |
| Number Of Beneficiaries Age 75 to 84 | 428 |
| Number Of Beneficiaries Age Greater 84 | 237 |
| Number Of Female Beneficiaries | 886 |
| Number Of Male Beneficiaries | 544 |
| Number Of Non Hispanic White Beneficiaries | 641 |
| Number Of Black or African American Beneficiaries | 223 |
| Number Of AsianPacific Islander Beneficiaries | 244 |
| Number Of Hispanic Beneficiaries | 284 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 466 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 964 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.4339 |