| National Provider Identifier [NPI]: | 1053632596 |
| Last Name Of The Provider | FANE |
| First Name Of The Provider | KATHLEEN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1316 W ONTARIO ST |
| Street Address 2 Of The Provider | 10TH FLOOR, JONES HALL |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191405220 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 375 |
| Number Of Medicare Beneficiaries | 242 |
| Total Submitted Charge Amount | 106638 |
| Total Medicare Allowed Amount | 40740.63 |
| Total Medicare Payment Amount | 30599.54 |
| Total Medicare Standardized Payment Amount | 28989.98 |
| 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 | 21 |
| Number Of Medical Services | 375 |
| Number Of Medicare Beneficiaries With Medical Services | 242 |
| Total Medical Submitted Charge Amount | 106638 |
| Total Medical Medicare Allowed Amount | 40740.63 |
| Total Medical Medicare Payment Amount | 30599.54 |
| Total Medical Medicare Standardized Payment Amount | 28989.98 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 115 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 119 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 134 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 73 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 169 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.4286 |