| National Provider Identifier [NPI]: | 1548268733 |
| Last Name Of The Provider | FOG |
| First Name Of The Provider | DENISE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 748 KINGS HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBURY |
| Zip Code Of The Provider | 080963157 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 169 |
| Number Of Services | 15853.4 |
| Number Of Medicare Beneficiaries | 2071 |
| Total Submitted Charge Amount | 1929763.5 |
| Total Medicare Allowed Amount | 452948.61 |
| Total Medicare Payment Amount | 348252.17 |
| Total Medicare Standardized Payment Amount | 329197.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 12877.4 |
| Number Of Medicare Beneficiaries With Drug Services | 269 |
| Total Drug Submitted ChargeAmount | 39693.5 |
| Total Drug Medicare AllowedAmount | 7069.24 |
| Total Drug Medicare PaymentAmount | 5530.47 |
| Total Drug Medicare Standardized Payment Amount | 5530.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 2976 |
| Number Of Medicare Beneficiaries With Medical Services | 2071 |
| Total Medical Submitted Charge Amount | 1890070 |
| Total Medical Medicare Allowed Amount | 445879.37 |
| Total Medical Medicare Payment Amount | 342721.7 |
| Total Medical Medicare Standardized Payment Amount | 323666.75 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 348 |
| Number Of Beneficiaries Age 65 to 74 | 809 |
| Number Of Beneficiaries Age 75 to 84 | 563 |
| Number Of Beneficiaries Age Greater 84 | 351 |
| Number Of Female Beneficiaries | 1289 |
| Number Of Male Beneficiaries | 782 |
| Number Of Non Hispanic White Beneficiaries | 1791 |
| Number Of Black or African American Beneficiaries | 210 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1705 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 366 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5351 |