| National Provider Identifier [NPI]: | 1255368395 |
| Last Name Of The Provider | MIKOLAJCZAK |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | SILVER CROSS HOSPITAL |
| Street Address 2 Of The Provider | 1200 MAPLE RD |
| City Of The Provider | JOLIET |
| Zip Code Of The Provider | 60432 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 572 |
| Number Of Medicare Beneficiaries | 536 |
| Total Submitted Charge Amount | 407790 |
| Total Medicare Allowed Amount | 94908.95 |
| Total Medicare Payment Amount | 72837.63 |
| Total Medicare Standardized Payment Amount | 68487.42 |
| 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 | 18 |
| Number Of Medical Services | 572 |
| Number Of Medicare Beneficiaries With Medical Services | 536 |
| Total Medical Submitted Charge Amount | 407790 |
| Total Medical Medicare Allowed Amount | 94908.95 |
| Total Medical Medicare Payment Amount | 72837.63 |
| Total Medical Medicare Standardized Payment Amount | 68487.42 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 326 |
| Number Of Male Beneficiaries | 210 |
| Number Of Non Hispanic White Beneficiaries | 452 |
| Number Of Black or African American Beneficiaries | 55 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 423 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.1203 |