| National Provider Identifier [NPI]: | 1669546453 |
| Last Name Of The Provider | GHALILI |
| First Name Of The Provider | STEVEN |
| 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 | 648 E 21ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900111146 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 952 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 83310 |
| Total Medicare Allowed Amount | 53570.14 |
| Total Medicare Payment Amount | 32938.47 |
| Total Medicare Standardized Payment Amount | 32373.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 1720 |
| Total Drug Medicare AllowedAmount | 630.86 |
| Total Drug Medicare PaymentAmount | 616.09 |
| Total Drug Medicare Standardized Payment Amount | 616.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 899 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 81590 |
| Total Medical Medicare Allowed Amount | 52939.28 |
| Total Medical Medicare Payment Amount | 32322.38 |
| Total Medical Medicare Standardized Payment Amount | 31757.42 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 77 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 24 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 141 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 7 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1919 |