| National Provider Identifier [NPI]: | 1346281250 |
| Last Name Of The Provider | FISH |
| First Name Of The Provider | FREDERICK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7205 UNIVERSITY AVE NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FRIDLEY |
| Zip Code Of The Provider | 554323134 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 2437 |
| Number Of Medicare Beneficiaries | 363 |
| Total Submitted Charge Amount | 622327 |
| Total Medicare Allowed Amount | 335278.21 |
| Total Medicare Payment Amount | 255029.07 |
| Total Medicare Standardized Payment Amount | 228175.53 |
| 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 | 59 |
| Number Of Medical Services | 2437 |
| Number Of Medicare Beneficiaries With Medical Services | 363 |
| Total Medical Submitted Charge Amount | 622327 |
| Total Medical Medicare Allowed Amount | 335278.21 |
| Total Medical Medicare Payment Amount | 255029.07 |
| Total Medical Medicare Standardized Payment Amount | 228175.53 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 211 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 349 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1081 |