| National Provider Identifier [NPI]: | 1578570842 |
| Last Name Of The Provider | FERNANDEZ |
| First Name Of The Provider | DOLORES |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 W UNIVERSITY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHAMPAIGN |
| Zip Code Of The Provider | 618203909 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 35891 |
| Number Of Medicare Beneficiaries | 3176 |
| Total Submitted Charge Amount | 5436366.33 |
| Total Medicare Allowed Amount | 724489.17 |
| Total Medicare Payment Amount | 563771.01 |
| Total Medicare Standardized Payment Amount | 613962.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 29150 |
| Number Of Medicare Beneficiaries With Drug Services | 524 |
| Total Drug Submitted ChargeAmount | 92084 |
| Total Drug Medicare AllowedAmount | 16103.4 |
| Total Drug Medicare PaymentAmount | 12556.22 |
| Total Drug Medicare Standardized Payment Amount | 12556.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 202 |
| Number Of Medical Services | 6741 |
| Number Of Medicare Beneficiaries With Medical Services | 3176 |
| Total Medical Submitted Charge Amount | 5344282.33 |
| Total Medical Medicare Allowed Amount | 708385.77 |
| Total Medical Medicare Payment Amount | 551214.79 |
| Total Medical Medicare Standardized Payment Amount | 601406.67 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 484 |
| Number Of Beneficiaries Age 65 to 74 | 1441 |
| Number Of Beneficiaries Age 75 to 84 | 911 |
| Number Of Beneficiaries Age Greater 84 | 340 |
| Number Of Female Beneficiaries | 2173 |
| Number Of Male Beneficiaries | 1003 |
| Number Of Non Hispanic White Beneficiaries | 2796 |
| Number Of Black or African American Beneficiaries | 294 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2649 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 527 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1789 |