| National Provider Identifier [NPI]: | 1710915038 |
| Last Name Of The Provider | DERBOGHOSSIANS |
| First Name Of The Provider | SHAHIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1030 S GLENDALE AVE |
| Street Address 2 Of The Provider | 301 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 912055612 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 8186 |
| Number Of Medicare Beneficiaries | 913 |
| Total Submitted Charge Amount | 2498437.5 |
| Total Medicare Allowed Amount | 1280580.36 |
| Total Medicare Payment Amount | 1002861.66 |
| Total Medicare Standardized Payment Amount | 939691.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 622 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 497600 |
| Total Drug Medicare AllowedAmount | 137205.13 |
| Total Drug Medicare PaymentAmount | 107453.43 |
| Total Drug Medicare Standardized Payment Amount | 107453.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 7564 |
| Number Of Medicare Beneficiaries With Medical Services | 912 |
| Total Medical Submitted Charge Amount | 2000837.5 |
| Total Medical Medicare Allowed Amount | 1143375.23 |
| Total Medical Medicare Payment Amount | 895408.23 |
| Total Medical Medicare Standardized Payment Amount | 832238.15 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 411 |
| Number Of Beneficiaries Age 75 to 84 | 327 |
| Number Of Beneficiaries Age Greater 84 | 127 |
| Number Of Female Beneficiaries | 182 |
| Number Of Male Beneficiaries | 731 |
| Number Of Non Hispanic White Beneficiaries | 721 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 79 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 93 |
| Number Of Beneficiaries With Medicare Only Entitlement | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 867 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 67 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.432 |