| National Provider Identifier [NPI]: | 1245260538 |
| Last Name Of The Provider | FAN |
| First Name Of The Provider | WARREN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 637 NORTH 13TH AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | UPLAND |
| Zip Code Of The Provider | 91786 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 235 |
| Number Of Medicare Beneficiaries | 126 |
| Total Submitted Charge Amount | 33905 |
| Total Medicare Allowed Amount | 24230.41 |
| Total Medicare Payment Amount | 15785.67 |
| Total Medicare Standardized Payment Amount | 15183.47 |
| 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 | 11 |
| Number Of Medical Services | 235 |
| Number Of Medicare Beneficiaries With Medical Services | 126 |
| Total Medical Submitted Charge Amount | 33905 |
| Total Medical Medicare Allowed Amount | 24230.41 |
| Total Medical Medicare Payment Amount | 15785.67 |
| Total Medical Medicare Standardized Payment Amount | 15183.47 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 73 |
| Number Of Male Beneficiaries | 53 |
| Number Of Non Hispanic White Beneficiaries | 55 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 57 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 28 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.8846 |