| National Provider Identifier [NPI]: | 1942249131 |
| Last Name Of The Provider | CORDOBA |
| First Name Of The Provider | ADRIAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2200 FORT JESSE RD |
| Street Address 2 Of The Provider | SUITE 280 |
| City Of The Provider | NORMAL |
| Zip Code Of The Provider | 617616286 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 147 |
| Number Of Services | 7821 |
| Number Of Medicare Beneficiaries | 3213 |
| Total Submitted Charge Amount | 888293.9 |
| Total Medicare Allowed Amount | 236616.29 |
| Total Medicare Payment Amount | 193497.7 |
| Total Medicare Standardized Payment Amount | 202356.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2010 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 2029.9 |
| Total Drug Medicare AllowedAmount | 442.87 |
| Total Drug Medicare PaymentAmount | 347.2 |
| Total Drug Medicare Standardized Payment Amount | 347.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 145 |
| Number Of Medical Services | 5811 |
| Number Of Medicare Beneficiaries With Medical Services | 3213 |
| Total Medical Submitted Charge Amount | 886264 |
| Total Medical Medicare Allowed Amount | 236173.42 |
| Total Medical Medicare Payment Amount | 193150.5 |
| Total Medical Medicare Standardized Payment Amount | 202009.27 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 397 |
| Number Of Beneficiaries Age 65 to 74 | 1393 |
| Number Of Beneficiaries Age 75 to 84 | 916 |
| Number Of Beneficiaries Age Greater 84 | 507 |
| Number Of Female Beneficiaries | 2233 |
| Number Of Male Beneficiaries | 980 |
| Number Of Non Hispanic White Beneficiaries | 3014 |
| Number Of Black or African American Beneficiaries | 123 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2678 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 535 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3418 |