| National Provider Identifier [NPI]: | 1346205515 |
| Last Name Of The Provider | FORTUNATO |
| First Name Of The Provider | ROBERT |
| 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 | 38 MONTVALE AVE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | STONEHAM |
| Zip Code Of The Provider | 021802446 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 140 |
| Number Of Services | 4700 |
| Number Of Medicare Beneficiaries | 2979 |
| Total Submitted Charge Amount | 350605 |
| Total Medicare Allowed Amount | 130722.1 |
| Total Medicare Payment Amount | 104618.55 |
| Total Medicare Standardized Payment Amount | 101378.23 |
| 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 | 140 |
| Number Of Medical Services | 4700 |
| Number Of Medicare Beneficiaries With Medical Services | 2979 |
| Total Medical Submitted Charge Amount | 350605 |
| Total Medical Medicare Allowed Amount | 130722.1 |
| Total Medical Medicare Payment Amount | 104618.55 |
| Total Medical Medicare Standardized Payment Amount | 101378.23 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 317 |
| Number Of Beneficiaries Age 65 to 74 | 1178 |
| Number Of Beneficiaries Age 75 to 84 | 947 |
| Number Of Beneficiaries Age Greater 84 | 537 |
| Number Of Female Beneficiaries | 2019 |
| Number Of Male Beneficiaries | 960 |
| Number Of Non Hispanic White Beneficiaries | 2857 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2487 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 492 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3513 |