| National Provider Identifier [NPI]: | 1912910423 |
| Last Name Of The Provider | FADUL |
| First Name Of The Provider | NADA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 DOCTORS PARK |
| Street Address 2 Of The Provider | ECU PHYSICIANS INFECTIOUS DISEASE |
| City Of The Provider | GREENVILLE |
| Zip Code Of The Provider | 278342801 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 636 |
| Number Of Medicare Beneficiaries | 322 |
| Total Submitted Charge Amount | 119811.61 |
| Total Medicare Allowed Amount | 56793.03 |
| Total Medicare Payment Amount | 43752.23 |
| Total Medicare Standardized Payment Amount | 45891.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 52 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 5217.2 |
| Total Drug Medicare AllowedAmount | 2734.75 |
| Total Drug Medicare PaymentAmount | 2679.97 |
| Total Drug Medicare Standardized Payment Amount | 2679.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 584 |
| Number Of Medicare Beneficiaries With Medical Services | 322 |
| Total Medical Submitted Charge Amount | 114594.41 |
| Total Medical Medicare Allowed Amount | 54058.28 |
| Total Medical Medicare Payment Amount | 41072.26 |
| Total Medical Medicare Standardized Payment Amount | 43211.58 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 169 |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 138 |
| Number Of Male Beneficiaries | 184 |
| Number Of Non Hispanic White Beneficiaries | 141 |
| Number Of Black or African American Beneficiaries | 170 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 147 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 175 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.6255 |