| National Provider Identifier [NPI]: | 1053375857 |
| Last Name Of The Provider | FISH |
| First Name Of The Provider | TED |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3211 N NORTHHILLS BLVD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | FAYETTEVILLE |
| Zip Code Of The Provider | 727034007 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 6280 |
| Number Of Medicare Beneficiaries | 1386 |
| Total Submitted Charge Amount | 798909 |
| Total Medicare Allowed Amount | 315940.58 |
| Total Medicare Payment Amount | 225365.27 |
| Total Medicare Standardized Payment Amount | 250681.89 |
| 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 | 82 |
| Number Of Medical Services | 6280 |
| Number Of Medicare Beneficiaries With Medical Services | 1386 |
| Total Medical Submitted Charge Amount | 798909 |
| Total Medical Medicare Allowed Amount | 315940.58 |
| Total Medical Medicare Payment Amount | 225365.27 |
| Total Medical Medicare Standardized Payment Amount | 250681.89 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 163 |
| Number Of Beneficiaries Age 65 to 74 | 515 |
| Number Of Beneficiaries Age 75 to 84 | 491 |
| Number Of Beneficiaries Age Greater 84 | 217 |
| Number Of Female Beneficiaries | 670 |
| Number Of Male Beneficiaries | 716 |
| Number Of Non Hispanic White Beneficiaries | 1330 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 23 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1179 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 207 |
| Percent Of With Atrial Fibrillation | 36 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4076 |