| National Provider Identifier [NPI]: | 1669466652 |
| Last Name Of The Provider | FUDGE |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5950 UNIVERSITY |
| Street Address 2 Of The Provider | STE 231 |
| City Of The Provider | WEST DES MOINES |
| Zip Code Of The Provider | 502668289 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 68 |
| Number Of Services | 7060 |
| Number Of Medicare Beneficiaries | 3091 |
| Total Submitted Charge Amount | 1209818.95 |
| Total Medicare Allowed Amount | 501694.22 |
| Total Medicare Payment Amount | 375568.8 |
| Total Medicare Standardized Payment Amount | 403717.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 84 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 7980 |
| Total Drug Medicare AllowedAmount | 4446.02 |
| Total Drug Medicare PaymentAmount | 3485.61 |
| Total Drug Medicare Standardized Payment Amount | 3485.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 6976 |
| Number Of Medicare Beneficiaries With Medical Services | 3091 |
| Total Medical Submitted Charge Amount | 1201838.95 |
| Total Medical Medicare Allowed Amount | 497248.2 |
| Total Medical Medicare Payment Amount | 372083.19 |
| Total Medical Medicare Standardized Payment Amount | 400232.1 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 305 |
| Number Of Beneficiaries Age 65 to 74 | 1021 |
| Number Of Beneficiaries Age 75 to 84 | 1063 |
| Number Of Beneficiaries Age Greater 84 | 702 |
| Number Of Female Beneficiaries | 1570 |
| Number Of Male Beneficiaries | 1521 |
| Number Of Non Hispanic White Beneficiaries | 2961 |
| Number Of Black or African American Beneficiaries | 74 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2638 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 453 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5184 |