| National Provider Identifier [NPI]: | 1649292566 |
| Last Name Of The Provider | FORTGANG |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 LONG WHARF DR |
| Street Address 2 Of The Provider | SUITE 302 |
| City Of The Provider | NEW HAVEN |
| Zip Code Of The Provider | 065115991 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 2869 |
| Number Of Medicare Beneficiaries | 1023 |
| Total Submitted Charge Amount | 387268.23 |
| Total Medicare Allowed Amount | 165974.99 |
| Total Medicare Payment Amount | 117548.29 |
| Total Medicare Standardized Payment Amount | 111570.29 |
| 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 | 65 |
| Number Of Medical Services | 2869 |
| Number Of Medicare Beneficiaries With Medical Services | 1023 |
| Total Medical Submitted Charge Amount | 387268.23 |
| Total Medical Medicare Allowed Amount | 165974.99 |
| Total Medical Medicare Payment Amount | 117548.29 |
| Total Medical Medicare Standardized Payment Amount | 111570.29 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 312 |
| Number Of Beneficiaries Age 75 to 84 | 298 |
| Number Of Beneficiaries Age Greater 84 | 242 |
| Number Of Female Beneficiaries | 597 |
| Number Of Male Beneficiaries | 426 |
| Number Of Non Hispanic White Beneficiaries | 900 |
| Number Of Black or African American Beneficiaries | 75 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 729 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 294 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1817 |