| National Provider Identifier [NPI]: | 1942378682 |
| Last Name Of The Provider | FOGEL |
| First Name Of The Provider | ANDREW |
| 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 | HENRY FORD HEALTH SYSTEM |
| Street Address 2 Of The Provider | 2799 WEST GRAND BOULEVARD |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 48202 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 209 |
| Number Of Services | 3062 |
| Number Of Medicare Beneficiaries | 1493 |
| Total Submitted Charge Amount | 553070 |
| Total Medicare Allowed Amount | 152190.9 |
| Total Medicare Payment Amount | 117882.33 |
| Total Medicare Standardized Payment Amount | 111239.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 209 |
| Number Of Medical Services | 3062 |
| Number Of Medicare Beneficiaries With Medical Services | 1493 |
| Total Medical Submitted Charge Amount | 553070 |
| Total Medical Medicare Allowed Amount | 152190.9 |
| Total Medical Medicare Payment Amount | 117882.33 |
| Total Medical Medicare Standardized Payment Amount | 111239.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 261 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 398 |
| Number Of Beneficiaries Age Greater 84 | 358 |
| Number Of Female Beneficiaries | 857 |
| Number Of Male Beneficiaries | 636 |
| Number Of Non Hispanic White Beneficiaries | 1069 |
| Number Of Black or African American Beneficiaries | 213 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 178 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 988 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 505 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2203 |