| National Provider Identifier [NPI]: | 1518068063 |
| Last Name Of The Provider | FAIRFAX |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2451 E BASELINE RD |
| Street Address 2 Of The Provider | SUITE 440 |
| City Of The Provider | GILBERT |
| Zip Code Of The Provider | 852342471 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 2173 |
| Number Of Medicare Beneficiaries | 461 |
| Total Submitted Charge Amount | 214077 |
| Total Medicare Allowed Amount | 128777.75 |
| Total Medicare Payment Amount | 85094.03 |
| Total Medicare Standardized Payment Amount | 88511.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 981 |
| Number Of Medicare Beneficiaries With Drug Services | 65 |
| Total Drug Submitted ChargeAmount | 7836 |
| Total Drug Medicare AllowedAmount | 1747.36 |
| Total Drug Medicare PaymentAmount | 1136.48 |
| Total Drug Medicare Standardized Payment Amount | 1136.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 1192 |
| Number Of Medicare Beneficiaries With Medical Services | 461 |
| Total Medical Submitted Charge Amount | 206241 |
| Total Medical Medicare Allowed Amount | 127030.39 |
| Total Medical Medicare Payment Amount | 83957.55 |
| Total Medical Medicare Standardized Payment Amount | 87374.96 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 215 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 359 |
| Number Of Male Beneficiaries | 102 |
| Number Of Non Hispanic White Beneficiaries | 374 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 359 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2341 |