| National Provider Identifier [NPI]: | 1104148014 |
| Last Name Of The Provider | CHANDRASOMA |
| First Name Of The Provider | SHAHIN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| 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 | ROOM 5900 |
| 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 | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 6735 |
| Number Of Medicare Beneficiaries | 462 |
| Total Submitted Charge Amount | 865804.01 |
| Total Medicare Allowed Amount | 364548.76 |
| Total Medicare Payment Amount | 274729.88 |
| Total Medicare Standardized Payment Amount | 253684.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 2385 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 43655 |
| Total Drug Medicare AllowedAmount | 20028.64 |
| Total Drug Medicare PaymentAmount | 15673.04 |
| Total Drug Medicare Standardized Payment Amount | 15673.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 4350 |
| Number Of Medicare Beneficiaries With Medical Services | 462 |
| Total Medical Submitted Charge Amount | 822149.01 |
| Total Medical Medicare Allowed Amount | 344520.12 |
| Total Medical Medicare Payment Amount | 259056.84 |
| Total Medical Medicare Standardized Payment Amount | 238011.22 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 178 |
| Number Of Beneficiaries Age 75 to 84 | 161 |
| Number Of Beneficiaries Age Greater 84 | 99 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 344 |
| Number Of Non Hispanic White Beneficiaries | 377 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 384 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3958 |