| National Provider Identifier [NPI]: | 1013900331 |
| Last Name Of The Provider | FISKE |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 411 30TH ST |
| Street Address 2 Of The Provider | #508 |
| City Of The Provider | OAKLAND |
| Zip Code Of The Provider | 946093310 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 23648 |
| Number Of Medicare Beneficiaries | 3160 |
| Total Submitted Charge Amount | 2650785.04 |
| Total Medicare Allowed Amount | 862232.55 |
| Total Medicare Payment Amount | 689492.32 |
| Total Medicare Standardized Payment Amount | 602883.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 18312 |
| Number Of Medicare Beneficiaries With Drug Services | 243 |
| Total Drug Submitted ChargeAmount | 25840.12 |
| Total Drug Medicare AllowedAmount | 8734.62 |
| Total Drug Medicare PaymentAmount | 6483.14 |
| Total Drug Medicare Standardized Payment Amount | 6483.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 189 |
| Number Of Medical Services | 5336 |
| Number Of Medicare Beneficiaries With Medical Services | 3145 |
| Total Medical Submitted Charge Amount | 2624944.92 |
| Total Medical Medicare Allowed Amount | 853497.93 |
| Total Medical Medicare Payment Amount | 683009.18 |
| Total Medical Medicare Standardized Payment Amount | 596400.11 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 231 |
| Number Of Beneficiaries Age 65 to 74 | 1629 |
| Number Of Beneficiaries Age 75 to 84 | 910 |
| Number Of Beneficiaries Age Greater 84 | 390 |
| Number Of Female Beneficiaries | 2228 |
| Number Of Male Beneficiaries | 932 |
| Number Of Non Hispanic White Beneficiaries | 2508 |
| Number Of Black or African American Beneficiaries | 126 |
| Number Of AsianPacific Islander Beneficiaries | 286 |
| Number Of Hispanic Beneficiaries | 140 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2616 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 544 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0925 |