| National Provider Identifier [NPI]: | 1669476446 |
| Last Name Of The Provider | FAGELMAN |
| First Name Of The Provider | DONALD |
| 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 | 301 EAST MAIN ST. |
| Street Address 2 Of The Provider | NSLIJ- SOUTHSIDE HOSPITAL, DEPT. OF RADIOLOGY |
| City Of The Provider | BAY SHORE |
| Zip Code Of The Provider | 11706 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 5779 |
| Number Of Medicare Beneficiaries | 2462 |
| Total Submitted Charge Amount | 558869.24 |
| Total Medicare Allowed Amount | 126616.1 |
| Total Medicare Payment Amount | 98303.18 |
| Total Medicare Standardized Payment Amount | 88336.87 |
| 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 | 103 |
| Number Of Medical Services | 5779 |
| Number Of Medicare Beneficiaries With Medical Services | 2462 |
| Total Medical Submitted Charge Amount | 558869.24 |
| Total Medical Medicare Allowed Amount | 126616.1 |
| Total Medical Medicare Payment Amount | 98303.18 |
| Total Medical Medicare Standardized Payment Amount | 88336.87 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 465 |
| Number Of Beneficiaries Age 65 to 74 | 637 |
| Number Of Beneficiaries Age 75 to 84 | 790 |
| Number Of Beneficiaries Age Greater 84 | 570 |
| Number Of Female Beneficiaries | 1369 |
| Number Of Male Beneficiaries | 1093 |
| Number Of Non Hispanic White Beneficiaries | 1880 |
| Number Of Black or African American Beneficiaries | 244 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 271 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1606 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 856 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 74 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0707 |