| National Provider Identifier [NPI]: | 1790983518 |
| Last Name Of The Provider | FADUL |
| First Name Of The Provider | DALIA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4255 ALTAMONT PL |
| Street Address 2 Of The Provider | STE 104 |
| City Of The Provider | WHITE PLAINS |
| Zip Code Of The Provider | 206953023 |
| 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 | 137 |
| Number Of Services | 20384 |
| Number Of Medicare Beneficiaries | 1120 |
| Total Submitted Charge Amount | 1332882 |
| Total Medicare Allowed Amount | 371429.33 |
| Total Medicare Payment Amount | 285168.51 |
| Total Medicare Standardized Payment Amount | 277537.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 17833 |
| Number Of Medicare Beneficiaries With Drug Services | 147 |
| Total Drug Submitted ChargeAmount | 21324 |
| Total Drug Medicare AllowedAmount | 6226.07 |
| Total Drug Medicare PaymentAmount | 4862.32 |
| Total Drug Medicare Standardized Payment Amount | 4862.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 132 |
| Number Of Medical Services | 2551 |
| Number Of Medicare Beneficiaries With Medical Services | 1120 |
| Total Medical Submitted Charge Amount | 1311558 |
| Total Medical Medicare Allowed Amount | 365203.26 |
| Total Medical Medicare Payment Amount | 280306.19 |
| Total Medical Medicare Standardized Payment Amount | 272674.86 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 153 |
| Number Of Beneficiaries Age 65 to 74 | 581 |
| Number Of Beneficiaries Age 75 to 84 | 299 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 689 |
| Number Of Male Beneficiaries | 431 |
| Number Of Non Hispanic White Beneficiaries | 830 |
| Number Of Black or African American Beneficiaries | 234 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1001 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1366 |