| National Provider Identifier [NPI]: | 1831280494 |
| Last Name Of The Provider | FAGAN |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | JOLIET RADIOLOGICAL SERVICES CORP PROVENA ST. JOESPH ME |
| Street Address 2 Of The Provider | 333 N MADISON ST |
| City Of The Provider | JOLIET |
| Zip Code Of The Provider | 60435 |
| 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 | 225 |
| Number Of Services | 6220 |
| Number Of Medicare Beneficiaries | 3613 |
| Total Submitted Charge Amount | 1076629 |
| Total Medicare Allowed Amount | 276731.15 |
| Total Medicare Payment Amount | 208016.74 |
| Total Medicare Standardized Payment Amount | 200464.43 |
| 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 | 225 |
| Number Of Medical Services | 6220 |
| Number Of Medicare Beneficiaries With Medical Services | 3613 |
| Total Medical Submitted Charge Amount | 1076629 |
| Total Medical Medicare Allowed Amount | 276731.15 |
| Total Medical Medicare Payment Amount | 208016.74 |
| Total Medical Medicare Standardized Payment Amount | 200464.43 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 627 |
| Number Of Beneficiaries Age 65 to 74 | 1161 |
| Number Of Beneficiaries Age 75 to 84 | 1096 |
| Number Of Beneficiaries Age Greater 84 | 729 |
| Number Of Female Beneficiaries | 2114 |
| Number Of Male Beneficiaries | 1499 |
| Number Of Non Hispanic White Beneficiaries | 2981 |
| Number Of Black or African American Beneficiaries | 381 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 193 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2723 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 890 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0179 |