| National Provider Identifier [NPI]: | 1245420447 |
| Last Name Of The Provider | FOUNTAIN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 816 D ST |
| Street Address 2 Of The Provider | APT 13 |
| City Of The Provider | SACRAMENTO |
| Zip Code Of The Provider | 958140719 |
| 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 | 164 |
| Number Of Services | 13011 |
| Number Of Medicare Beneficiaries | 4024 |
| Total Submitted Charge Amount | 1051312.35 |
| Total Medicare Allowed Amount | 252605.81 |
| Total Medicare Payment Amount | 196545.47 |
| Total Medicare Standardized Payment Amount | 188268.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 7253 |
| Number Of Medicare Beneficiaries With Drug Services | 100 |
| Total Drug Submitted ChargeAmount | 7769 |
| Total Drug Medicare AllowedAmount | 1733.46 |
| Total Drug Medicare PaymentAmount | 1359.1 |
| Total Drug Medicare Standardized Payment Amount | 1359.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 160 |
| Number Of Medical Services | 5758 |
| Number Of Medicare Beneficiaries With Medical Services | 4024 |
| Total Medical Submitted Charge Amount | 1043543.35 |
| Total Medical Medicare Allowed Amount | 250872.35 |
| Total Medical Medicare Payment Amount | 195186.37 |
| Total Medical Medicare Standardized Payment Amount | 186909.36 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 640 |
| Number Of Beneficiaries Age 65 to 74 | 1457 |
| Number Of Beneficiaries Age 75 to 84 | 1209 |
| Number Of Beneficiaries Age Greater 84 | 718 |
| Number Of Female Beneficiaries | 2441 |
| Number Of Male Beneficiaries | 1583 |
| Number Of Non Hispanic White Beneficiaries | 3213 |
| Number Of Black or African American Beneficiaries | 235 |
| Number Of AsianPacific Islander Beneficiaries | 210 |
| Number Of Hispanic Beneficiaries | 269 |
| Number Of American Indian Alaska Native Beneficiaries | 27 |
| Number Of Beneficiaries With Race Not Else where Classified | 70 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2958 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1066 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6151 |