| National Provider Identifier [NPI]: | 1679520365 |
| Last Name Of The Provider | FAN |
| First Name Of The Provider | QING |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6817 SOUTHPOINT PKWY |
| Street Address 2 Of The Provider | #503 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322166282 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 1181 |
| Number Of Medicare Beneficiaries | 441 |
| Total Submitted Charge Amount | 283551.46 |
| Total Medicare Allowed Amount | 114952.04 |
| Total Medicare Payment Amount | 87498.65 |
| Total Medicare Standardized Payment Amount | 91794.96 |
| 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 | 21 |
| Number Of Medical Services | 1181 |
| Number Of Medicare Beneficiaries With Medical Services | 441 |
| Total Medical Submitted Charge Amount | 283551.46 |
| Total Medical Medicare Allowed Amount | 114952.04 |
| Total Medical Medicare Payment Amount | 87498.65 |
| Total Medical Medicare Standardized Payment Amount | 91794.96 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 85 |
| Number Of Beneficiaries Age 65 to 74 | 138 |
| Number Of Beneficiaries Age 75 to 84 | 122 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | 358 |
| Number Of Black or African American Beneficiaries | 67 |
| 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 | 299 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 142 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.0531 |