| National Provider Identifier [NPI]: | 1861561672 |
| Last Name Of The Provider | FAHEY |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 411 HAMILTON BLVD |
| Street Address 2 Of The Provider | 1824 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021144 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 7887 |
| Number Of Medicare Beneficiaries | 3717 |
| Total Submitted Charge Amount | 744157 |
| Total Medicare Allowed Amount | 140770.19 |
| Total Medicare Payment Amount | 106184.82 |
| Total Medicare Standardized Payment Amount | 108004.89 |
| 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 | 93 |
| Number Of Medical Services | 7887 |
| Number Of Medicare Beneficiaries With Medical Services | 3717 |
| Total Medical Submitted Charge Amount | 744157 |
| Total Medical Medicare Allowed Amount | 140770.19 |
| Total Medical Medicare Payment Amount | 106184.82 |
| Total Medical Medicare Standardized Payment Amount | 108004.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 664 |
| Number Of Beneficiaries Age 65 to 74 | 1328 |
| Number Of Beneficiaries Age 75 to 84 | 1135 |
| Number Of Beneficiaries Age Greater 84 | 590 |
| Number Of Female Beneficiaries | 1888 |
| Number Of Male Beneficiaries | 1829 |
| Number Of Non Hispanic White Beneficiaries | 3389 |
| Number Of Black or African American Beneficiaries | 208 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2828 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 889 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.9356 |