| National Provider Identifier [NPI]: | 1972702603 |
| Last Name Of The Provider | FABIAN |
| First Name Of The Provider | ALLISON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6105 WILSON AVE SW |
| Street Address 2 Of The Provider | SUITE 204 |
| City Of The Provider | GRANDVILLE |
| Zip Code Of The Provider | 494189714 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 341 |
| Number Of Medicare Beneficiaries | 106 |
| Total Submitted Charge Amount | 39145 |
| Total Medicare Allowed Amount | 21997.92 |
| Total Medicare Payment Amount | 15023.03 |
| Total Medicare Standardized Payment Amount | 16824.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1502 |
| Total Drug Medicare AllowedAmount | 954.58 |
| Total Drug Medicare PaymentAmount | 934.2 |
| Total Drug Medicare Standardized Payment Amount | 934.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 306 |
| Number Of Medicare Beneficiaries With Medical Services | 105 |
| Total Medical Submitted Charge Amount | 37643 |
| Total Medical Medicare Allowed Amount | 21043.34 |
| Total Medical Medicare Payment Amount | 14088.83 |
| Total Medical Medicare Standardized Payment Amount | 15890.1 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 85 |
| Number Of Male Beneficiaries | 21 |
| Number Of Non Hispanic White Beneficiaries | 93 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 82 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 37 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8277 |