| National Provider Identifier [NPI]: | 1902024987 |
| Last Name Of The Provider | TAVACKOLI |
| First Name Of The Provider | SHAHIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 GESSNER RD |
| Street Address 2 Of The Provider | SUITE 630 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 77024 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 5171 |
| Number Of Medicare Beneficiaries | 1208 |
| Total Submitted Charge Amount | 755185 |
| Total Medicare Allowed Amount | 405322.46 |
| Total Medicare Payment Amount | 306848.53 |
| Total Medicare Standardized Payment Amount | 305165.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 140 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 11200 |
| Total Drug Medicare AllowedAmount | 7412.99 |
| Total Drug Medicare PaymentAmount | 5678.51 |
| Total Drug Medicare Standardized Payment Amount | 5678.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 5031 |
| Number Of Medicare Beneficiaries With Medical Services | 1208 |
| Total Medical Submitted Charge Amount | 743985 |
| Total Medical Medicare Allowed Amount | 397909.47 |
| Total Medical Medicare Payment Amount | 301170.02 |
| Total Medical Medicare Standardized Payment Amount | 299486.83 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 385 |
| Number Of Beneficiaries Age 75 to 84 | 411 |
| Number Of Beneficiaries Age Greater 84 | 304 |
| Number Of Female Beneficiaries | 684 |
| Number Of Male Beneficiaries | 524 |
| Number Of Non Hispanic White Beneficiaries | 918 |
| Number Of Black or African American Beneficiaries | 104 |
| Number Of AsianPacific Islander Beneficiaries | 62 |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 958 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 250 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.0623 |