| National Provider Identifier [NPI]: | 1346205184 |
| Last Name Of The Provider | FONTAINE |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 703 RIVERWAY PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEDFORD |
| Zip Code Of The Provider | 031106768 |
| State Code Of The Provider | NH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 206 |
| Number Of Services | 8374 |
| Number Of Medicare Beneficiaries | 5071 |
| Total Submitted Charge Amount | 711291 |
| Total Medicare Allowed Amount | 222938.29 |
| Total Medicare Payment Amount | 168676.92 |
| Total Medicare Standardized Payment Amount | 169224.99 |
| 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 | 206 |
| Number Of Medical Services | 8374 |
| Number Of Medicare Beneficiaries With Medical Services | 5071 |
| Total Medical Submitted Charge Amount | 711291 |
| Total Medical Medicare Allowed Amount | 222938.29 |
| Total Medical Medicare Payment Amount | 168676.92 |
| Total Medical Medicare Standardized Payment Amount | 169224.99 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1019 |
| Number Of Beneficiaries Age 65 to 74 | 1677 |
| Number Of Beneficiaries Age 75 to 84 | 1474 |
| Number Of Beneficiaries Age Greater 84 | 901 |
| Number Of Female Beneficiaries | 3057 |
| Number Of Male Beneficiaries | 2014 |
| Number Of Non Hispanic White Beneficiaries | 4857 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 93 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 53 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3883 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1188 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4906 |