| National Provider Identifier [NPI]: | 1912972423 |
| Last Name Of The Provider | FISH |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3 BRIDGE STREET |
| Street Address 2 Of The Provider | SUITE 3 |
| City Of The Provider | CARTHAGE |
| Zip Code Of The Provider | 13619 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 17223 |
| Number Of Medicare Beneficiaries | 804 |
| Total Submitted Charge Amount | 592290.54 |
| Total Medicare Allowed Amount | 452794.58 |
| Total Medicare Payment Amount | 346473.41 |
| Total Medicare Standardized Payment Amount | 363011.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 470 |
| Number Of Medicare Beneficiaries With Drug Services | 375 |
| Total Drug Submitted ChargeAmount | 16943.53 |
| Total Drug Medicare AllowedAmount | 10568.46 |
| Total Drug Medicare PaymentAmount | 9818.19 |
| Total Drug Medicare Standardized Payment Amount | 9818.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 16753 |
| Number Of Medicare Beneficiaries With Medical Services | 804 |
| Total Medical Submitted Charge Amount | 575347.01 |
| Total Medical Medicare Allowed Amount | 442226.12 |
| Total Medical Medicare Payment Amount | 336655.22 |
| Total Medical Medicare Standardized Payment Amount | 353192.91 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 139 |
| Number Of Beneficiaries Age 65 to 74 | 363 |
| Number Of Beneficiaries Age 75 to 84 | 227 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 455 |
| Number Of Male Beneficiaries | 349 |
| Number Of Non Hispanic White Beneficiaries | 774 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 645 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 159 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0472 |