| National Provider Identifier [NPI]: | 1760588263 |
| Last Name Of The Provider | FOWLKES |
| First Name Of The Provider | WILLIAM |
| 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 | 67 THOMAS JOHNSON DR |
| Street Address 2 Of The Provider | SUITE 4 |
| City Of The Provider | FREDERICK |
| Zip Code Of The Provider | 217024863 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 124 |
| Number Of Services | 20852 |
| Number Of Medicare Beneficiaries | 3290 |
| Total Submitted Charge Amount | 2505841.56 |
| Total Medicare Allowed Amount | 821658.1 |
| Total Medicare Payment Amount | 656870 |
| Total Medicare Standardized Payment Amount | 582134.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15971 |
| Number Of Medicare Beneficiaries With Drug Services | 475 |
| Total Drug Submitted ChargeAmount | 32707.9 |
| Total Drug Medicare AllowedAmount | 13860.02 |
| Total Drug Medicare PaymentAmount | 9963.97 |
| Total Drug Medicare Standardized Payment Amount | 9963.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 120 |
| Number Of Medical Services | 4881 |
| Number Of Medicare Beneficiaries With Medical Services | 3290 |
| Total Medical Submitted Charge Amount | 2473133.66 |
| Total Medical Medicare Allowed Amount | 807798.08 |
| Total Medical Medicare Payment Amount | 646906.03 |
| Total Medical Medicare Standardized Payment Amount | 572170.76 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 355 |
| Number Of Beneficiaries Age 65 to 74 | 1625 |
| Number Of Beneficiaries Age 75 to 84 | 934 |
| Number Of Beneficiaries Age Greater 84 | 376 |
| Number Of Female Beneficiaries | 2432 |
| Number Of Male Beneficiaries | 858 |
| Number Of Non Hispanic White Beneficiaries | 1917 |
| Number Of Black or African American Beneficiaries | 890 |
| Number Of AsianPacific Islander Beneficiaries | 213 |
| Number Of Hispanic Beneficiaries | 203 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 67 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2713 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 577 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.0801 |