| National Provider Identifier [NPI]: | 1245280833 |
| Last Name Of The Provider | FAWCETT |
| First Name Of The Provider | HENRI |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 815 PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761042224 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 10054 |
| Number Of Medicare Beneficiaries | 5396 |
| Total Submitted Charge Amount | 432422 |
| Total Medicare Allowed Amount | 116796.44 |
| Total Medicare Payment Amount | 86611.81 |
| Total Medicare Standardized Payment Amount | 88084.34 |
| 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 | 100 |
| Number Of Medical Services | 10054 |
| Number Of Medicare Beneficiaries With Medical Services | 5396 |
| Total Medical Submitted Charge Amount | 432422 |
| Total Medical Medicare Allowed Amount | 116796.44 |
| Total Medical Medicare Payment Amount | 86611.81 |
| Total Medical Medicare Standardized Payment Amount | 88084.34 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1156 |
| Number Of Beneficiaries Age 65 to 74 | 1826 |
| Number Of Beneficiaries Age 75 to 84 | 1519 |
| Number Of Beneficiaries Age Greater 84 | 895 |
| Number Of Female Beneficiaries | 3112 |
| Number Of Male Beneficiaries | 2284 |
| Number Of Non Hispanic White Beneficiaries | 4004 |
| Number Of Black or African American Beneficiaries | 809 |
| Number Of AsianPacific Islander Beneficiaries | 42 |
| Number Of Hispanic Beneficiaries | 495 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3783 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1613 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.3497 |