| National Provider Identifier [NPI]: | 1750322319 |
| Last Name Of The Provider | FERNANDEZ |
| First Name Of The Provider | GASPAR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 701 N 1ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627810001 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 196 |
| Number Of Services | 8073 |
| Number Of Medicare Beneficiaries | 4449 |
| Total Submitted Charge Amount | 767904 |
| Total Medicare Allowed Amount | 214112.37 |
| Total Medicare Payment Amount | 155412.78 |
| Total Medicare Standardized Payment Amount | 165729.62 |
| 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 | 196 |
| Number Of Medical Services | 8073 |
| Number Of Medicare Beneficiaries With Medical Services | 4449 |
| Total Medical Submitted Charge Amount | 767904 |
| Total Medical Medicare Allowed Amount | 214112.37 |
| Total Medical Medicare Payment Amount | 155412.78 |
| Total Medical Medicare Standardized Payment Amount | 165729.62 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1175 |
| Number Of Beneficiaries Age 65 to 74 | 1441 |
| Number Of Beneficiaries Age 75 to 84 | 1232 |
| Number Of Beneficiaries Age Greater 84 | 601 |
| Number Of Female Beneficiaries | 2756 |
| Number Of Male Beneficiaries | 1693 |
| Number Of Non Hispanic White Beneficiaries | 4368 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3040 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1409 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4791 |