| National Provider Identifier [NPI]: | 1164483780 |
| Last Name Of The Provider | FIDEL |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 951 NW 13TH ST |
| Street Address 2 Of The Provider | SUITE 1C |
| City Of The Provider | BOCA RATON |
| Zip Code Of The Provider | 334862359 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 161 |
| Number Of Services | 5782 |
| Number Of Medicare Beneficiaries | 4304 |
| Total Submitted Charge Amount | 603271 |
| Total Medicare Allowed Amount | 244133.23 |
| Total Medicare Payment Amount | 190834.17 |
| Total Medicare Standardized Payment Amount | 183808.25 |
| 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 | 161 |
| Number Of Medical Services | 5782 |
| Number Of Medicare Beneficiaries With Medical Services | 4304 |
| Total Medical Submitted Charge Amount | 603271 |
| Total Medical Medicare Allowed Amount | 244133.23 |
| Total Medical Medicare Payment Amount | 190834.17 |
| Total Medical Medicare Standardized Payment Amount | 183808.25 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 129 |
| Number Of Beneficiaries Age 65 to 74 | 1295 |
| Number Of Beneficiaries Age 75 to 84 | 1607 |
| Number Of Beneficiaries Age Greater 84 | 1273 |
| Number Of Female Beneficiaries | 2460 |
| Number Of Male Beneficiaries | 1844 |
| Number Of Non Hispanic White Beneficiaries | 4042 |
| Number Of Black or African American Beneficiaries | 51 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 150 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 199 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.608 |