| National Provider Identifier [NPI]: | 1265521611 |
| Last Name Of The Provider | MOUSSAVI |
| First Name Of The Provider | SOHAIL |
| 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 | 12604 LAKE RIDGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBRIDGE |
| Zip Code Of The Provider | 221922335 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 2656 |
| Number Of Medicare Beneficiaries | 607 |
| Total Submitted Charge Amount | 314345.85 |
| Total Medicare Allowed Amount | 188728.59 |
| Total Medicare Payment Amount | 131615.48 |
| Total Medicare Standardized Payment Amount | 136448.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 187 |
| Number Of Medicare Beneficiaries With Drug Services | 175 |
| Total Drug Submitted ChargeAmount | 6895 |
| Total Drug Medicare AllowedAmount | 2723.97 |
| Total Drug Medicare PaymentAmount | 2669.27 |
| Total Drug Medicare Standardized Payment Amount | 2669.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 2469 |
| Number Of Medicare Beneficiaries With Medical Services | 607 |
| Total Medical Submitted Charge Amount | 307450.85 |
| Total Medical Medicare Allowed Amount | 186004.62 |
| Total Medical Medicare Payment Amount | 128946.21 |
| Total Medical Medicare Standardized Payment Amount | 133778.9 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 293 |
| Number Of Beneficiaries Age 75 to 84 | 187 |
| Number Of Beneficiaries Age Greater 84 | 76 |
| Number Of Female Beneficiaries | 323 |
| Number Of Male Beneficiaries | 284 |
| Number Of Non Hispanic White Beneficiaries | 462 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3245 |