| National Provider Identifier [NPI]: | 1316990849 |
| Last Name Of The Provider | FIESER |
| First Name Of The Provider | CARL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2004 1ST AVE |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | DODGE CITY |
| Zip Code Of The Provider | 678012623 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 204 |
| Number Of Services | 8094 |
| Number Of Medicare Beneficiaries | 3498 |
| Total Submitted Charge Amount | 754493.5 |
| Total Medicare Allowed Amount | 208849.33 |
| Total Medicare Payment Amount | 159838.77 |
| Total Medicare Standardized Payment Amount | 167026.84 |
| 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 | 204 |
| Number Of Medical Services | 8094 |
| Number Of Medicare Beneficiaries With Medical Services | 3498 |
| Total Medical Submitted Charge Amount | 754493.5 |
| Total Medical Medicare Allowed Amount | 208849.33 |
| Total Medical Medicare Payment Amount | 159838.77 |
| Total Medical Medicare Standardized Payment Amount | 167026.84 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 350 |
| Number Of Beneficiaries Age 65 to 74 | 1235 |
| Number Of Beneficiaries Age 75 to 84 | 1199 |
| Number Of Beneficiaries Age Greater 84 | 714 |
| Number Of Female Beneficiaries | 2219 |
| Number Of Male Beneficiaries | 1279 |
| Number Of Non Hispanic White Beneficiaries | 3268 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 164 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2867 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 631 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1623 |