| National Provider Identifier [NPI]: | 1477589091 |
| Last Name Of The Provider | FELLMETH |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6305 COYLE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARMICHAEL |
| Zip Code Of The Provider | 956080438 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 256 |
| Number Of Services | 8604 |
| Number Of Medicare Beneficiaries | 1932 |
| Total Submitted Charge Amount | 1617188.9 |
| Total Medicare Allowed Amount | 167194.98 |
| Total Medicare Payment Amount | 129469.08 |
| Total Medicare Standardized Payment Amount | 128899.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 5677 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 6402.2 |
| Total Drug Medicare AllowedAmount | 1279.24 |
| Total Drug Medicare PaymentAmount | 1002.86 |
| Total Drug Medicare Standardized Payment Amount | 1002.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 253 |
| Number Of Medical Services | 2927 |
| Number Of Medicare Beneficiaries With Medical Services | 1932 |
| Total Medical Submitted Charge Amount | 1610786.7 |
| Total Medical Medicare Allowed Amount | 165915.74 |
| Total Medical Medicare Payment Amount | 128466.22 |
| Total Medical Medicare Standardized Payment Amount | 127896.58 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 430 |
| Number Of Beneficiaries Age 65 to 74 | 635 |
| Number Of Beneficiaries Age 75 to 84 | 516 |
| Number Of Beneficiaries Age Greater 84 | 351 |
| Number Of Female Beneficiaries | 1088 |
| Number Of Male Beneficiaries | 844 |
| Number Of Non Hispanic White Beneficiaries | 1209 |
| Number Of Black or African American Beneficiaries | 219 |
| Number Of AsianPacific Islander Beneficiaries | 256 |
| Number Of Hispanic Beneficiaries | 204 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 966 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 966 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.2672 |