| National Provider Identifier [NPI]: | 1891752770 |
| Last Name Of The Provider | FASTLICH |
| First Name Of The Provider | IRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 150 E SUNRISE HWY |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | LINDENHURST |
| Zip Code Of The Provider | 117572598 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 9403 |
| Number Of Medicare Beneficiaries | 3757 |
| Total Submitted Charge Amount | 1385361.15 |
| Total Medicare Allowed Amount | 645618.57 |
| Total Medicare Payment Amount | 475054.64 |
| Total Medicare Standardized Payment Amount | 404422.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 5158 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 1985.54 |
| Total Drug Medicare AllowedAmount | 1195.99 |
| Total Drug Medicare PaymentAmount | 926.72 |
| Total Drug Medicare Standardized Payment Amount | 926.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 103 |
| Number Of Medical Services | 4245 |
| Number Of Medicare Beneficiaries With Medical Services | 3757 |
| Total Medical Submitted Charge Amount | 1383375.61 |
| Total Medical Medicare Allowed Amount | 644422.58 |
| Total Medical Medicare Payment Amount | 474127.92 |
| Total Medical Medicare Standardized Payment Amount | 403495.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 652 |
| Number Of Beneficiaries Age 65 to 74 | 1591 |
| Number Of Beneficiaries Age 75 to 84 | 1102 |
| Number Of Beneficiaries Age Greater 84 | 412 |
| Number Of Female Beneficiaries | 2284 |
| Number Of Male Beneficiaries | 1473 |
| Number Of Non Hispanic White Beneficiaries | 3229 |
| Number Of Black or African American Beneficiaries | 161 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 197 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 107 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3123 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 634 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.214 |