| National Provider Identifier [NPI]: | 1659360931 |
| Last Name Of The Provider | KOURTU |
| First Name Of The Provider | MOHAMED |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2 W CRESCENT PARK |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 163652111 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 116 |
| Number Of Services | 3999 |
| Number Of Medicare Beneficiaries | 705 |
| Total Submitted Charge Amount | 939879.31 |
| Total Medicare Allowed Amount | 334116.16 |
| Total Medicare Payment Amount | 261291.66 |
| Total Medicare Standardized Payment Amount | 249252.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 342 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 2719.6 |
| Total Drug Medicare AllowedAmount | 957.58 |
| Total Drug Medicare PaymentAmount | 699.94 |
| Total Drug Medicare Standardized Payment Amount | 699.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 111 |
| Number Of Medical Services | 3657 |
| Number Of Medicare Beneficiaries With Medical Services | 704 |
| Total Medical Submitted Charge Amount | 937159.71 |
| Total Medical Medicare Allowed Amount | 333158.58 |
| Total Medical Medicare Payment Amount | 260591.72 |
| Total Medical Medicare Standardized Payment Amount | 248552.08 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 184 |
| Number Of Beneficiaries Age 65 to 74 | 255 |
| Number Of Beneficiaries Age 75 to 84 | 193 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 396 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 676 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 495 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 210 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.4312 |