| National Provider Identifier [NPI]: | 1578756524 |
| Last Name Of The Provider | FRAGOSO |
| First Name Of The Provider | JOSE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 SPRUCE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191076130 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 196 |
| Number Of Services | 9916 |
| Number Of Medicare Beneficiaries | 5355 |
| Total Submitted Charge Amount | 2215390.71 |
| Total Medicare Allowed Amount | 371674.07 |
| Total Medicare Payment Amount | 287378.17 |
| Total Medicare Standardized Payment Amount | 276087.16 |
| 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 | 196 |
| Number Of Medical Services | 9916 |
| Number Of Medicare Beneficiaries With Medical Services | 5355 |
| Total Medical Submitted Charge Amount | 2215390.71 |
| Total Medical Medicare Allowed Amount | 371674.07 |
| Total Medical Medicare Payment Amount | 287378.17 |
| Total Medical Medicare Standardized Payment Amount | 276087.16 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 205 |
| Number Of Beneficiaries Age 65 to 74 | 1890 |
| Number Of Beneficiaries Age 75 to 84 | 2040 |
| Number Of Beneficiaries Age Greater 84 | 1220 |
| Number Of Female Beneficiaries | 3042 |
| Number Of Male Beneficiaries | 2313 |
| Number Of Non Hispanic White Beneficiaries | 5108 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 58 |
| Number Of Beneficiaries With Medicare Only Entitlement | 5075 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 280 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.511 |