| National Provider Identifier [NPI]: | 1215207048 |
| Last Name Of The Provider | FANOUS |
| First Name Of The Provider | RANDY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 W ARBOR DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921039000 |
| 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 | 198 |
| Number Of Services | 4706 |
| Number Of Medicare Beneficiaries | 2697 |
| Total Submitted Charge Amount | 760275.02 |
| Total Medicare Allowed Amount | 183575.62 |
| Total Medicare Payment Amount | 139529.9 |
| Total Medicare Standardized Payment Amount | 132284.23 |
| 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 | 198 |
| Number Of Medical Services | 4706 |
| Number Of Medicare Beneficiaries With Medical Services | 2697 |
| Total Medical Submitted Charge Amount | 760275.02 |
| Total Medical Medicare Allowed Amount | 183575.62 |
| Total Medical Medicare Payment Amount | 139529.9 |
| Total Medical Medicare Standardized Payment Amount | 132284.23 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 178 |
| Number Of Beneficiaries Age 65 to 74 | 920 |
| Number Of Beneficiaries Age 75 to 84 | 940 |
| Number Of Beneficiaries Age Greater 84 | 659 |
| Number Of Female Beneficiaries | 1661 |
| Number Of Male Beneficiaries | 1036 |
| Number Of Non Hispanic White Beneficiaries | 2006 |
| Number Of Black or African American Beneficiaries | 106 |
| Number Of AsianPacific Islander Beneficiaries | 251 |
| Number Of Hispanic Beneficiaries | 267 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2229 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 468 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.581 |