| National Provider Identifier [NPI]: | 1023272200 |
| Last Name Of The Provider | FERNANDO |
| First Name Of The Provider | SUJAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9200 W WISCONSIN AVE |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532263522 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 146 |
| Number Of Services | 11132 |
| Number Of Medicare Beneficiaries | 2200 |
| Total Submitted Charge Amount | 528601.04 |
| Total Medicare Allowed Amount | 128323.31 |
| Total Medicare Payment Amount | 97140.31 |
| Total Medicare Standardized Payment Amount | 105841.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 7645 |
| Number Of Medicare Beneficiaries With Drug Services | 86 |
| Total Drug Submitted ChargeAmount | 14300.53 |
| Total Drug Medicare AllowedAmount | 2397.55 |
| Total Drug Medicare PaymentAmount | 1707.9 |
| Total Drug Medicare Standardized Payment Amount | 1707.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 140 |
| Number Of Medical Services | 3487 |
| Number Of Medicare Beneficiaries With Medical Services | 2198 |
| Total Medical Submitted Charge Amount | 514300.51 |
| Total Medical Medicare Allowed Amount | 125925.76 |
| Total Medical Medicare Payment Amount | 95432.41 |
| Total Medical Medicare Standardized Payment Amount | 104133.13 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 490 |
| Number Of Beneficiaries Age 65 to 74 | 822 |
| Number Of Beneficiaries Age 75 to 84 | 605 |
| Number Of Beneficiaries Age Greater 84 | 283 |
| Number Of Female Beneficiaries | 1277 |
| Number Of Male Beneficiaries | 923 |
| Number Of Non Hispanic White Beneficiaries | 1724 |
| Number Of Black or African American Beneficiaries | 341 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 69 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 38 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1666 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 534 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.7837 |