| National Provider Identifier [NPI]: | 1134151194 |
| Last Name Of The Provider | FENNAR |
| First Name Of The Provider | TAD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1300 W 6TH ST |
| Street Address 2 Of The Provider | SUITE 2 |
| City Of The Provider | SAN PEDRO |
| Zip Code Of The Provider | 907323531 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 25304 |
| Number Of Medicare Beneficiaries | 3681 |
| Total Submitted Charge Amount | 1311605 |
| Total Medicare Allowed Amount | 784785.19 |
| Total Medicare Payment Amount | 613342.06 |
| Total Medicare Standardized Payment Amount | 580014.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 25304 |
| Number Of Medicare Beneficiaries With Medical Services | 3681 |
| Total Medical Submitted Charge Amount | 1311605 |
| Total Medical Medicare Allowed Amount | 784785.19 |
| Total Medical Medicare Payment Amount | 613342.06 |
| Total Medical Medicare Standardized Payment Amount | 580014.8 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 561 |
| Number Of Beneficiaries Age 65 to 74 | 801 |
| Number Of Beneficiaries Age 75 to 84 | 1038 |
| Number Of Beneficiaries Age Greater 84 | 1281 |
| Number Of Female Beneficiaries | 2117 |
| Number Of Male Beneficiaries | 1564 |
| Number Of Non Hispanic White Beneficiaries | 1816 |
| Number Of Black or African American Beneficiaries | 501 |
| Number Of AsianPacific Islander Beneficiaries | 572 |
| Number Of Hispanic Beneficiaries | 730 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 50 |
| Number Of Beneficiaries With Medicare Only Entitlement | 661 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 3020 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 65 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 40 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.9787 |