| National Provider Identifier [NPI]: | 1225014731 |
| Last Name Of The Provider | FOXMAN |
| First Name Of The Provider | ETHAN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 85 SEYMOUR ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061065501 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 2487 |
| Number Of Medicare Beneficiaries | 919 |
| Total Submitted Charge Amount | 324287 |
| Total Medicare Allowed Amount | 65414.05 |
| Total Medicare Payment Amount | 50625.14 |
| Total Medicare Standardized Payment Amount | 49061.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1160 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 5250 |
| Total Drug Medicare AllowedAmount | 542.39 |
| Total Drug Medicare PaymentAmount | 425.23 |
| Total Drug Medicare Standardized Payment Amount | 425.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 1327 |
| Number Of Medicare Beneficiaries With Medical Services | 919 |
| Total Medical Submitted Charge Amount | 319037 |
| Total Medical Medicare Allowed Amount | 64871.66 |
| Total Medical Medicare Payment Amount | 50199.91 |
| Total Medical Medicare Standardized Payment Amount | 48636.21 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 242 |
| Number Of Beneficiaries Age 75 to 84 | 254 |
| Number Of Beneficiaries Age Greater 84 | 250 |
| Number Of Female Beneficiaries | 518 |
| Number Of Male Beneficiaries | 401 |
| Number Of Non Hispanic White Beneficiaries | 710 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 105 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 382 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.2292 |