| National Provider Identifier [NPI]: | 1356394969 |
| Last Name Of The Provider | FANKUCHEN |
| First Name Of The Provider | ELLIOTT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 31872 SOUTH COAST HIGHWAY |
| Street Address 2 Of The Provider | RADIOLOGY DEPARTMENT |
| City Of The Provider | LAGUNA BEACH |
| Zip Code Of The Provider | 92651 |
| 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 | 220 |
| Number Of Services | 6393 |
| Number Of Medicare Beneficiaries | 3691 |
| Total Submitted Charge Amount | 720457 |
| Total Medicare Allowed Amount | 193647.65 |
| Total Medicare Payment Amount | 145165.67 |
| Total Medicare Standardized Payment Amount | 136886.63 |
| 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 | 220 |
| Number Of Medical Services | 6393 |
| Number Of Medicare Beneficiaries With Medical Services | 3691 |
| Total Medical Submitted Charge Amount | 720457 |
| Total Medical Medicare Allowed Amount | 193647.65 |
| Total Medical Medicare Payment Amount | 145165.67 |
| Total Medical Medicare Standardized Payment Amount | 136886.63 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 279 |
| Number Of Beneficiaries Age 65 to 74 | 1160 |
| Number Of Beneficiaries Age 75 to 84 | 1159 |
| Number Of Beneficiaries Age Greater 84 | 1093 |
| Number Of Female Beneficiaries | 2171 |
| Number Of Male Beneficiaries | 1520 |
| Number Of Non Hispanic White Beneficiaries | 2780 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 539 |
| Number Of Hispanic Beneficiaries | 228 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 77 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2828 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 863 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8943 |