| National Provider Identifier [NPI]: | 1972524486 |
| Last Name Of The Provider | FAGAN |
| First Name Of The Provider | RONALD |
| 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 | 4900 HEMPSTEAD TPKE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FARMINGDALE |
| Zip Code Of The Provider | 117352028 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 137 |
| Number Of Services | 4689 |
| Number Of Medicare Beneficiaries | 684 |
| Total Submitted Charge Amount | 677518.41 |
| Total Medicare Allowed Amount | 399404.15 |
| Total Medicare Payment Amount | 296698.43 |
| Total Medicare Standardized Payment Amount | 264808.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 113 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 3725.78 |
| Total Drug Medicare AllowedAmount | 601.63 |
| Total Drug Medicare PaymentAmount | 543.56 |
| Total Drug Medicare Standardized Payment Amount | 543.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 4576 |
| Number Of Medicare Beneficiaries With Medical Services | 684 |
| Total Medical Submitted Charge Amount | 673792.63 |
| Total Medical Medicare Allowed Amount | 398802.52 |
| Total Medical Medicare Payment Amount | 296154.87 |
| Total Medical Medicare Standardized Payment Amount | 264265.11 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 306 |
| Number Of Beneficiaries Age 75 to 84 | 173 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 393 |
| Number Of Male Beneficiaries | 291 |
| Number Of Non Hispanic White Beneficiaries | 536 |
| Number Of Black or African American Beneficiaries | 86 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 561 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 123 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0574 |