| National Provider Identifier [NPI]: | 1104833052 |
| Last Name Of The Provider | FORTANASCE |
| First Name Of The Provider | VINCENT |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 665 W NAOMI AVE STE 201 |
| Street Address 2 Of The Provider | |
| City Of The Provider | ARCADIA |
| Zip Code Of The Provider | 910077563 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 4706 |
| Number Of Medicare Beneficiaries | 812 |
| Total Submitted Charge Amount | 962950 |
| Total Medicare Allowed Amount | 692674.46 |
| Total Medicare Payment Amount | 528322.89 |
| Total Medicare Standardized Payment Amount | 468570.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 335 |
| Total Drug Medicare AllowedAmount | 150.78 |
| Total Drug Medicare PaymentAmount | 107.98 |
| Total Drug Medicare Standardized Payment Amount | 107.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 4639 |
| Number Of Medicare Beneficiaries With Medical Services | 812 |
| Total Medical Submitted Charge Amount | 962615 |
| Total Medical Medicare Allowed Amount | 692523.68 |
| Total Medical Medicare Payment Amount | 528214.91 |
| Total Medical Medicare Standardized Payment Amount | 468462.86 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 251 |
| Number Of Beneficiaries Age 75 to 84 | 271 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 454 |
| Number Of Male Beneficiaries | 358 |
| Number Of Non Hispanic White Beneficiaries | 544 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | 66 |
| Number Of Hispanic Beneficiaries | 143 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 597 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 215 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 23 |
| Average HCC Risk Score Of Beneficiaries | 1.8562 |