| National Provider Identifier [NPI]: | 1962639757 |
| Last Name Of The Provider | FORTES |
| First Name Of The Provider | MANUEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3330 NW 56TH ST |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731124479 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 206 |
| Number Of Services | 8388 |
| Number Of Medicare Beneficiaries | 3154 |
| Total Submitted Charge Amount | 384178.58 |
| Total Medicare Allowed Amount | 328750.15 |
| Total Medicare Payment Amount | 247850.16 |
| Total Medicare Standardized Payment Amount | 266357.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3275 |
| Number Of Medicare Beneficiaries With Drug Services | 122 |
| Total Drug Submitted ChargeAmount | 4508.1 |
| Total Drug Medicare AllowedAmount | 3633.64 |
| Total Drug Medicare PaymentAmount | 2834.18 |
| Total Drug Medicare Standardized Payment Amount | 2834.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 204 |
| Number Of Medical Services | 5113 |
| Number Of Medicare Beneficiaries With Medical Services | 3154 |
| Total Medical Submitted Charge Amount | 379670.48 |
| Total Medical Medicare Allowed Amount | 325116.51 |
| Total Medical Medicare Payment Amount | 245015.98 |
| Total Medical Medicare Standardized Payment Amount | 263522.88 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 675 |
| Number Of Beneficiaries Age 65 to 74 | 1177 |
| Number Of Beneficiaries Age 75 to 84 | 866 |
| Number Of Beneficiaries Age Greater 84 | 436 |
| Number Of Female Beneficiaries | 1766 |
| Number Of Male Beneficiaries | 1388 |
| Number Of Non Hispanic White Beneficiaries | 2596 |
| Number Of Black or African American Beneficiaries | 273 |
| Number Of AsianPacific Islander Beneficiaries | 40 |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | 142 |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2356 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 798 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.1559 |