| National Provider Identifier [NPI]: | 1275523425 |
| Last Name Of The Provider | FUENTES-BERNARDO |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4411 THE 25 WAY NE |
| Street Address 2 Of The Provider | SUITE 150 |
| City Of The Provider | ALBUQUERQUE |
| Zip Code Of The Provider | 871095857 |
| State Code Of The Provider | NM |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 263 |
| Number Of Services | 2464 |
| Number Of Medicare Beneficiaries | 1536 |
| Total Submitted Charge Amount | 427363.39 |
| Total Medicare Allowed Amount | 117049.45 |
| Total Medicare Payment Amount | 89787.39 |
| Total Medicare Standardized Payment Amount | 92334.07 |
| 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 | 263 |
| Number Of Medical Services | 2464 |
| Number Of Medicare Beneficiaries With Medical Services | 1536 |
| Total Medical Submitted Charge Amount | 427363.39 |
| Total Medical Medicare Allowed Amount | 117049.45 |
| Total Medical Medicare Payment Amount | 89787.39 |
| Total Medical Medicare Standardized Payment Amount | 92334.07 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 331 |
| Number Of Beneficiaries Age 65 to 74 | 542 |
| Number Of Beneficiaries Age 75 to 84 | 449 |
| Number Of Beneficiaries Age Greater 84 | 214 |
| Number Of Female Beneficiaries | 886 |
| Number Of Male Beneficiaries | 650 |
| Number Of Non Hispanic White Beneficiaries | 636 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 817 |
| Number Of American Indian Alaska Native Beneficiaries | 46 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 813 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 723 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.4887 |