National Provider Identifier [NPI]: |
1407830243 |
Last Name Of The Provider |
FANAPOUR |
First Name Of The Provider |
FREDERICK |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4440 W 95TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
OAK LAWN |
Zip Code Of The Provider |
604532600 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
125 |
Number Of Services |
4304 |
Number Of Medicare Beneficiaries |
2809 |
Total Submitted Charge Amount |
1020180.42 |
Total Medicare Allowed Amount |
150243.3 |
Total Medicare Payment Amount |
114390.85 |
Total Medicare Standardized Payment Amount |
110154.5 |
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 |
125 |
Number Of Medical Services |
4304 |
Number Of Medicare Beneficiaries With Medical Services |
2809 |
Total Medical Submitted Charge Amount |
1020180.42 |
Total Medical Medicare Allowed Amount |
150243.3 |
Total Medical Medicare Payment Amount |
114390.85 |
Total Medical Medicare Standardized Payment Amount |
110154.5 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
491 |
Number Of Beneficiaries Age 65 to 74 |
875 |
Number Of Beneficiaries Age 75 to 84 |
899 |
Number Of Beneficiaries Age Greater 84 |
544 |
Number Of Female Beneficiaries |
1656 |
Number Of Male Beneficiaries |
1153 |
Number Of Non Hispanic White Beneficiaries |
1705 |
Number Of Black or African American Beneficiaries |
833 |
Number Of AsianPacific Islander Beneficiaries |
33 |
Number Of Hispanic Beneficiaries |
208 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
1947 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
862 |
Percent Of With Atrial Fibrillation |
27 |
Percent Of With Alzheimers Disease or Dementia |
27 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
52 |
Percent Of With Chronic Kidney Disease |
56 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
52 |
Percent Of With Hyperlipidemia |
72 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
63 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
58 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
20 |
Average HCC Risk Score Of Beneficiaries |
2.3203 |