| National Provider Identifier [NPI]: | 1104899616 |
| Last Name Of The Provider | FERTILE |
| First Name Of The Provider | JAY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 MARTHA JEFFERSON DR |
| Street Address 2 Of The Provider | CHARLOTTESVILLE RADIOLOGY |
| City Of The Provider | CHARLOTTESVILLE |
| Zip Code Of The Provider | 229114668 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 183 |
| Number Of Services | 6728 |
| Number Of Medicare Beneficiaries | 4018 |
| Total Submitted Charge Amount | 629606 |
| Total Medicare Allowed Amount | 179802.51 |
| Total Medicare Payment Amount | 138024.75 |
| Total Medicare Standardized Payment Amount | 142347.77 |
| 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 | 183 |
| Number Of Medical Services | 6728 |
| Number Of Medicare Beneficiaries With Medical Services | 4018 |
| Total Medical Submitted Charge Amount | 629606 |
| Total Medical Medicare Allowed Amount | 179802.51 |
| Total Medical Medicare Payment Amount | 138024.75 |
| Total Medical Medicare Standardized Payment Amount | 142347.77 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 419 |
| Number Of Beneficiaries Age 65 to 74 | 1734 |
| Number Of Beneficiaries Age 75 to 84 | 1259 |
| Number Of Beneficiaries Age Greater 84 | 606 |
| Number Of Female Beneficiaries | 2672 |
| Number Of Male Beneficiaries | 1346 |
| Number Of Non Hispanic White Beneficiaries | 3526 |
| Number Of Black or African American Beneficiaries | 404 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3532 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 486 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2236 |