| National Provider Identifier [NPI]: | 1437150679 |
| Last Name Of The Provider | MELLIERE |
| First Name Of The Provider | BRAD |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 W CENTRAL RD |
| Street Address 2 Of The Provider | NORTHWEST COMMUNITY HOSPITAL / RADIOLOGY DEPARTMENT |
| City Of The Provider | ARLINGTON HEIGHTS |
| Zip Code Of The Provider | 600052349 |
| 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 | 231 |
| Number Of Services | 5044 |
| Number Of Medicare Beneficiaries | 3006 |
| Total Submitted Charge Amount | 961627 |
| Total Medicare Allowed Amount | 253750 |
| Total Medicare Payment Amount | 200165.33 |
| Total Medicare Standardized Payment Amount | 183881.35 |
| 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 | 231 |
| Number Of Medical Services | 5044 |
| Number Of Medicare Beneficiaries With Medical Services | 3006 |
| Total Medical Submitted Charge Amount | 961627 |
| Total Medical Medicare Allowed Amount | 253750 |
| Total Medical Medicare Payment Amount | 200165.33 |
| Total Medical Medicare Standardized Payment Amount | 183881.35 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 210 |
| Number Of Beneficiaries Age 65 to 74 | 1056 |
| Number Of Beneficiaries Age 75 to 84 | 1080 |
| Number Of Beneficiaries Age Greater 84 | 660 |
| Number Of Female Beneficiaries | 1864 |
| Number Of Male Beneficiaries | 1142 |
| Number Of Non Hispanic White Beneficiaries | 2754 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 90 |
| Number Of Hispanic Beneficiaries | 87 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 38 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2589 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 417 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.615 |