| National Provider Identifier [NPI]: | 1366458408 |
| Last Name Of The Provider | FEDOSKY |
| First Name Of The Provider | ALLAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4554 E HIGHWAY 20 |
| Street Address 2 Of The Provider | |
| City Of The Provider | NICEVILLE |
| Zip Code Of The Provider | 325789755 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 1223 |
| Number Of Medicare Beneficiaries | 266 |
| Total Submitted Charge Amount | 150433 |
| Total Medicare Allowed Amount | 114474.28 |
| Total Medicare Payment Amount | 79008.16 |
| Total Medicare Standardized Payment Amount | 81081.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 60 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 722 |
| Total Drug Medicare AllowedAmount | 107.17 |
| Total Drug Medicare PaymentAmount | 71.38 |
| Total Drug Medicare Standardized Payment Amount | 71.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 1163 |
| Number Of Medicare Beneficiaries With Medical Services | 266 |
| Total Medical Submitted Charge Amount | 149711 |
| Total Medical Medicare Allowed Amount | 114367.11 |
| Total Medical Medicare Payment Amount | 78936.78 |
| Total Medical Medicare Standardized Payment Amount | 81010.05 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 141 |
| Number Of Beneficiaries Age 75 to 84 | 80 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 163 |
| Number Of Male Beneficiaries | 103 |
| Number Of Non Hispanic White Beneficiaries | 247 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7762 |