| National Provider Identifier [NPI]: | 1326026774 |
| Last Name Of The Provider | FANTELLI |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 307 W MAIN ST |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | KENT |
| Zip Code Of The Provider | 442402400 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 1595 |
| Number Of Medicare Beneficiaries | 272 |
| Total Submitted Charge Amount | 217645 |
| Total Medicare Allowed Amount | 113949.78 |
| Total Medicare Payment Amount | 84104.79 |
| Total Medicare Standardized Payment Amount | 86847.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 276 |
| Number Of Medicare Beneficiaries With Drug Services | 79 |
| Total Drug Submitted ChargeAmount | 5188 |
| Total Drug Medicare AllowedAmount | 2895.94 |
| Total Drug Medicare PaymentAmount | 2634.68 |
| Total Drug Medicare Standardized Payment Amount | 2634.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 1319 |
| Number Of Medicare Beneficiaries With Medical Services | 272 |
| Total Medical Submitted Charge Amount | 212457 |
| Total Medical Medicare Allowed Amount | 111053.84 |
| Total Medical Medicare Payment Amount | 81470.11 |
| Total Medical Medicare Standardized Payment Amount | 84213.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 72 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 146 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 256 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 213 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8277 |