| National Provider Identifier [NPI]: | 1487760351 |
| Last Name Of The Provider | FAN |
| First Name Of The Provider | IAIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 105 JULIUS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLARKS SUMMIT |
| Zip Code Of The Provider | 184118922 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 4430 |
| Number Of Medicare Beneficiaries | 3253 |
| Total Submitted Charge Amount | 444178 |
| Total Medicare Allowed Amount | 126498.29 |
| Total Medicare Payment Amount | 97268.77 |
| Total Medicare Standardized Payment Amount | 99338.5 |
| 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 | 117 |
| Number Of Medical Services | 4430 |
| Number Of Medicare Beneficiaries With Medical Services | 3253 |
| Total Medical Submitted Charge Amount | 444178 |
| Total Medical Medicare Allowed Amount | 126498.29 |
| Total Medical Medicare Payment Amount | 97268.77 |
| Total Medical Medicare Standardized Payment Amount | 99338.5 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 642 |
| Number Of Beneficiaries Age 65 to 74 | 993 |
| Number Of Beneficiaries Age 75 to 84 | 997 |
| Number Of Beneficiaries Age Greater 84 | 621 |
| Number Of Female Beneficiaries | 1837 |
| Number Of Male Beneficiaries | 1416 |
| Number Of Non Hispanic White Beneficiaries | 2395 |
| Number Of Black or African American Beneficiaries | 335 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 470 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1986 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1267 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.9084 |