| National Provider Identifier [NPI]: | 1386994812 |
| Last Name Of The Provider | FONGE |
| First Name Of The Provider | FELIX |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15 SALT CREEK LN |
| Street Address 2 Of The Provider | SUITE 111 |
| City Of The Provider | HINSDALE |
| Zip Code Of The Provider | 605212926 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 3724 |
| Number Of Medicare Beneficiaries | 714 |
| Total Submitted Charge Amount | 804689 |
| Total Medicare Allowed Amount | 335230.53 |
| Total Medicare Payment Amount | 256270.64 |
| Total Medicare Standardized Payment Amount | 286366.46 |
| 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 | 14 |
| Number Of Medical Services | 3724 |
| Number Of Medicare Beneficiaries With Medical Services | 714 |
| Total Medical Submitted Charge Amount | 804689 |
| Total Medical Medicare Allowed Amount | 335230.53 |
| Total Medical Medicare Payment Amount | 256270.64 |
| Total Medical Medicare Standardized Payment Amount | 286366.46 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 161 |
| Number Of Beneficiaries Age 65 to 74 | 201 |
| Number Of Beneficiaries Age 75 to 84 | 198 |
| Number Of Beneficiaries Age Greater 84 | 154 |
| Number Of Female Beneficiaries | 379 |
| Number Of Male Beneficiaries | 335 |
| Number Of Non Hispanic White Beneficiaries | 355 |
| Number Of Black or African American Beneficiaries | 252 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 254 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 460 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 52 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 54 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 32 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.9972 |