| National Provider Identifier [NPI]: | 1699746990 |
| Last Name Of The Provider | EJIANREH |
| First Name Of The Provider | FIDELIS |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2032 E PLEASANT VALLEY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALTOONA |
| Zip Code Of The Provider | 16602 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 1653 |
| Number Of Medicare Beneficiaries | 414 |
| Total Submitted Charge Amount | 217938 |
| Total Medicare Allowed Amount | 128135.8 |
| Total Medicare Payment Amount | 86816.42 |
| Total Medicare Standardized Payment Amount | 92376.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 99 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 3598 |
| Total Drug Medicare AllowedAmount | 2114.56 |
| Total Drug Medicare PaymentAmount | 2027.47 |
| Total Drug Medicare Standardized Payment Amount | 2027.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 1554 |
| Number Of Medicare Beneficiaries With Medical Services | 411 |
| Total Medical Submitted Charge Amount | 214340 |
| Total Medical Medicare Allowed Amount | 126021.24 |
| Total Medical Medicare Payment Amount | 84788.95 |
| Total Medical Medicare Standardized Payment Amount | 90349.11 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 68 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 248 |
| Number Of Male Beneficiaries | 166 |
| Number Of Non Hispanic White Beneficiaries | 397 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 284 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7389 |