| 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 |