| National Provider Identifier [NPI]: | 1245221506 |
| Last Name Of The Provider | FOGARTY |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5325 NORTHGATE DR |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | BETHLEHEM |
| Zip Code Of The Provider | 180179411 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 161 |
| Number Of Services | 9913 |
| Number Of Medicare Beneficiaries | 2451 |
| Total Submitted Charge Amount | 867291.5 |
| Total Medicare Allowed Amount | 273434.1 |
| Total Medicare Payment Amount | 221122.18 |
| Total Medicare Standardized Payment Amount | 235788.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 6738 |
| Number Of Medicare Beneficiaries With Drug Services | 111 |
| Total Drug Submitted ChargeAmount | 8839.5 |
| Total Drug Medicare AllowedAmount | 2564.82 |
| Total Drug Medicare PaymentAmount | 2010.74 |
| Total Drug Medicare Standardized Payment Amount | 2010.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 156 |
| Number Of Medical Services | 3175 |
| Number Of Medicare Beneficiaries With Medical Services | 2451 |
| Total Medical Submitted Charge Amount | 858452 |
| Total Medical Medicare Allowed Amount | 270869.28 |
| Total Medical Medicare Payment Amount | 219111.44 |
| Total Medical Medicare Standardized Payment Amount | 233777.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 271 |
| Number Of Beneficiaries Age 65 to 74 | 1086 |
| Number Of Beneficiaries Age 75 to 84 | 771 |
| Number Of Beneficiaries Age Greater 84 | 323 |
| Number Of Female Beneficiaries | 1684 |
| Number Of Male Beneficiaries | 767 |
| Number Of Non Hispanic White Beneficiaries | 2293 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 75 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2259 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 192 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0692 |