| National Provider Identifier [NPI]: | 1255523296 |
| Last Name Of The Provider | LEONE |
| First Name Of The Provider | DOUGLAS |
| 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 | 3024 E EMPIRE ST |
| Street Address 2 Of The Provider | STE E & F |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 617045402 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 129 |
| Number Of Services | 21672 |
| Number Of Medicare Beneficiaries | 2580 |
| Total Submitted Charge Amount | 3112690.98 |
| Total Medicare Allowed Amount | 1992640.02 |
| Total Medicare Payment Amount | 1504951.84 |
| Total Medicare Standardized Payment Amount | 1512882.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 906 |
| Number Of Medicare Beneficiaries With Drug Services | 218 |
| Total Drug Submitted ChargeAmount | 26535.52 |
| Total Drug Medicare AllowedAmount | 21246.78 |
| Total Drug Medicare PaymentAmount | 16210.69 |
| Total Drug Medicare Standardized Payment Amount | 16210.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 125 |
| Number Of Medical Services | 20766 |
| Number Of Medicare Beneficiaries With Medical Services | 2580 |
| Total Medical Submitted Charge Amount | 3086155.46 |
| Total Medical Medicare Allowed Amount | 1971393.24 |
| Total Medical Medicare Payment Amount | 1488741.15 |
| Total Medical Medicare Standardized Payment Amount | 1496672.2 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 223 |
| Number Of Beneficiaries Age 65 to 74 | 1098 |
| Number Of Beneficiaries Age 75 to 84 | 835 |
| Number Of Beneficiaries Age Greater 84 | 424 |
| Number Of Female Beneficiaries | 1359 |
| Number Of Male Beneficiaries | 1221 |
| Number Of Non Hispanic White Beneficiaries | 2507 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2283 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 297 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0188 |