| National Provider Identifier [NPI]: | 1992723332 |
| Last Name Of The Provider | FRY |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11800 E TWELVE MILE ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 48093 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 161 |
| Number Of Services | 7165 |
| Number Of Medicare Beneficiaries | 4302 |
| Total Submitted Charge Amount | 504812.1 |
| Total Medicare Allowed Amount | 235570.49 |
| Total Medicare Payment Amount | 180514.22 |
| Total Medicare Standardized Payment Amount | 175501.07 |
| 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 | 161 |
| Number Of Medical Services | 7165 |
| Number Of Medicare Beneficiaries With Medical Services | 4302 |
| Total Medical Submitted Charge Amount | 504812.1 |
| Total Medical Medicare Allowed Amount | 235570.49 |
| Total Medical Medicare Payment Amount | 180514.22 |
| Total Medical Medicare Standardized Payment Amount | 175501.07 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 974 |
| Number Of Beneficiaries Age 65 to 74 | 1204 |
| Number Of Beneficiaries Age 75 to 84 | 1185 |
| Number Of Beneficiaries Age Greater 84 | 939 |
| Number Of Female Beneficiaries | 2633 |
| Number Of Male Beneficiaries | 1669 |
| Number Of Non Hispanic White Beneficiaries | 3450 |
| Number Of Black or African American Beneficiaries | 653 |
| Number Of AsianPacific Islander Beneficiaries | 87 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 62 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2861 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1441 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.245 |