| National Provider Identifier [NPI]: | 1407879562 |
| Last Name Of The Provider | FLETCHER |
| First Name Of The Provider | DALE |
| 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 | 3015 N NEW BALLAS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST LOUIS |
| Zip Code Of The Provider | 63131 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 6875 |
| Number Of Medicare Beneficiaries | 3969 |
| Total Submitted Charge Amount | 564866 |
| Total Medicare Allowed Amount | 179989.78 |
| Total Medicare Payment Amount | 135298.52 |
| Total Medicare Standardized Payment Amount | 138598.81 |
| 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 | 210 |
| Number Of Medical Services | 6875 |
| Number Of Medicare Beneficiaries With Medical Services | 3969 |
| Total Medical Submitted Charge Amount | 564866 |
| Total Medical Medicare Allowed Amount | 179989.78 |
| Total Medical Medicare Payment Amount | 135298.52 |
| Total Medical Medicare Standardized Payment Amount | 138598.81 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 511 |
| Number Of Beneficiaries Age 65 to 74 | 1333 |
| Number Of Beneficiaries Age 75 to 84 | 1297 |
| Number Of Beneficiaries Age Greater 84 | 828 |
| Number Of Female Beneficiaries | 2242 |
| Number Of Male Beneficiaries | 1727 |
| Number Of Non Hispanic White Beneficiaries | 3491 |
| Number Of Black or African American Beneficiaries | 376 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3335 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 634 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9158 |