| National Provider Identifier [NPI]: | 1669466462 |
| Last Name Of The Provider | FABIAN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2625 TAMIAMI TRL |
| Street Address 2 Of The Provider | UNIT 1 |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 339526478 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 273 |
| Number Of Services | 56553 |
| Number Of Medicare Beneficiaries | 4381 |
| Total Submitted Charge Amount | 4174043.79 |
| Total Medicare Allowed Amount | 1578359.39 |
| Total Medicare Payment Amount | 1212434.26 |
| Total Medicare Standardized Payment Amount | 1234060.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 48440 |
| Number Of Medicare Beneficiaries With Drug Services | 768 |
| Total Drug Submitted ChargeAmount | 82841.95 |
| Total Drug Medicare AllowedAmount | 23549.92 |
| Total Drug Medicare PaymentAmount | 18393.55 |
| Total Drug Medicare Standardized Payment Amount | 18393.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 260 |
| Number Of Medical Services | 8113 |
| Number Of Medicare Beneficiaries With Medical Services | 4370 |
| Total Medical Submitted Charge Amount | 4091201.84 |
| Total Medical Medicare Allowed Amount | 1554809.47 |
| Total Medical Medicare Payment Amount | 1194040.71 |
| Total Medical Medicare Standardized Payment Amount | 1215666.6 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 358 |
| Number Of Beneficiaries Age 65 to 74 | 2015 |
| Number Of Beneficiaries Age 75 to 84 | 1514 |
| Number Of Beneficiaries Age Greater 84 | 494 |
| Number Of Female Beneficiaries | 2491 |
| Number Of Male Beneficiaries | 1890 |
| Number Of Non Hispanic White Beneficiaries | 4041 |
| Number Of Black or African American Beneficiaries | 136 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 118 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 58 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4019 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 362 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4157 |