| National Provider Identifier [NPI]: | 1285740464 |
| Last Name Of The Provider | FITZGIBBONS |
| First Name Of The Provider | TERRENCE |
| 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 | 1245 WILSHIRE BLVD |
| Street Address 2 Of The Provider | SUITE 905 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900174810 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 2869 |
| Number Of Medicare Beneficiaries | 463 |
| Total Submitted Charge Amount | 1830438.26 |
| Total Medicare Allowed Amount | 732498.94 |
| Total Medicare Payment Amount | 565971.37 |
| Total Medicare Standardized Payment Amount | 513924.35 |
| 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 | 121 |
| Number Of Medical Services | 2869 |
| Number Of Medicare Beneficiaries With Medical Services | 463 |
| Total Medical Submitted Charge Amount | 1830438.26 |
| Total Medical Medicare Allowed Amount | 732498.94 |
| Total Medical Medicare Payment Amount | 565971.37 |
| Total Medical Medicare Standardized Payment Amount | 513924.35 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 185 |
| Number Of Beneficiaries Age 75 to 84 | 151 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 271 |
| Number Of Male Beneficiaries | 192 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 109 |
| Number Of Hispanic Beneficiaries | 173 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 164 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 299 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.9375 |