| National Provider Identifier [NPI]: | 1841380359 |
| Last Name Of The Provider | VANWAGENEN |
| First Name Of The Provider | FARREL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2222 N NEVADA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLORADO SPRINGS |
| Zip Code Of The Provider | 809076819 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 218 |
| Number Of Services | 8167 |
| Number Of Medicare Beneficiaries | 2061 |
| Total Submitted Charge Amount | 477590.56 |
| Total Medicare Allowed Amount | 164425.9 |
| Total Medicare Payment Amount | 127230.32 |
| Total Medicare Standardized Payment Amount | 128810.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 5045 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 2543.56 |
| Total Drug Medicare AllowedAmount | 981.76 |
| Total Drug Medicare PaymentAmount | 769.4 |
| Total Drug Medicare Standardized Payment Amount | 769.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 216 |
| Number Of Medical Services | 3122 |
| Number Of Medicare Beneficiaries With Medical Services | 2061 |
| Total Medical Submitted Charge Amount | 475047 |
| Total Medical Medicare Allowed Amount | 163444.14 |
| Total Medical Medicare Payment Amount | 126460.92 |
| Total Medical Medicare Standardized Payment Amount | 128041.04 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 349 |
| Number Of Beneficiaries Age 65 to 74 | 808 |
| Number Of Beneficiaries Age 75 to 84 | 603 |
| Number Of Beneficiaries Age Greater 84 | 301 |
| Number Of Female Beneficiaries | 1212 |
| Number Of Male Beneficiaries | 849 |
| Number Of Non Hispanic White Beneficiaries | 1761 |
| Number Of Black or African American Beneficiaries | 92 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 152 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1742 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 319 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5909 |