| National Provider Identifier [NPI]: | 1356385223 |
| Last Name Of The Provider | FUGOSO |
| First Name Of The Provider | VALERIANO |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 197 |
| Number Of Services | 17384 |
| Number Of Medicare Beneficiaries | 3666 |
| Total Submitted Charge Amount | 1107049.76 |
| Total Medicare Allowed Amount | 338599.18 |
| Total Medicare Payment Amount | 255114.86 |
| Total Medicare Standardized Payment Amount | 244356.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 10428 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 2511.96 |
| Total Drug Medicare AllowedAmount | 2055.06 |
| Total Drug Medicare PaymentAmount | 1465.32 |
| Total Drug Medicare Standardized Payment Amount | 1465.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 195 |
| Number Of Medical Services | 6956 |
| Number Of Medicare Beneficiaries With Medical Services | 3666 |
| Total Medical Submitted Charge Amount | 1104537.8 |
| Total Medical Medicare Allowed Amount | 336544.12 |
| Total Medical Medicare Payment Amount | 253649.54 |
| Total Medical Medicare Standardized Payment Amount | 242891.58 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 466 |
| Number Of Beneficiaries Age 65 to 74 | 1259 |
| Number Of Beneficiaries Age 75 to 84 | 1140 |
| Number Of Beneficiaries Age Greater 84 | 801 |
| Number Of Female Beneficiaries | 2191 |
| Number Of Male Beneficiaries | 1475 |
| Number Of Non Hispanic White Beneficiaries | 3287 |
| Number Of Black or African American Beneficiaries | 277 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3055 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 611 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5657 |