| National Provider Identifier [NPI]: | 1336101690 |
| Last Name Of The Provider | FENNELL |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 842 E MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEDFORD |
| Zip Code Of The Provider | 975047134 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 173 |
| Number Of Services | 10004 |
| Number Of Medicare Beneficiaries | 4372 |
| Total Submitted Charge Amount | 681787.18 |
| Total Medicare Allowed Amount | 204252.66 |
| Total Medicare Payment Amount | 158394.55 |
| Total Medicare Standardized Payment Amount | 164618.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3273 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 6243.86 |
| Total Drug Medicare AllowedAmount | 1337.77 |
| Total Drug Medicare PaymentAmount | 1048.82 |
| Total Drug Medicare Standardized Payment Amount | 1048.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 171 |
| Number Of Medical Services | 6731 |
| Number Of Medicare Beneficiaries With Medical Services | 4371 |
| Total Medical Submitted Charge Amount | 675543.32 |
| Total Medical Medicare Allowed Amount | 202914.89 |
| Total Medical Medicare Payment Amount | 157345.73 |
| Total Medical Medicare Standardized Payment Amount | 163570.01 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 675 |
| Number Of Beneficiaries Age 65 to 74 | 1921 |
| Number Of Beneficiaries Age 75 to 84 | 1194 |
| Number Of Beneficiaries Age Greater 84 | 582 |
| Number Of Female Beneficiaries | 2716 |
| Number Of Male Beneficiaries | 1656 |
| Number Of Non Hispanic White Beneficiaries | 4115 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 133 |
| Number Of American Indian Alaska Native Beneficiaries | 45 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3468 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 904 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2955 |