| National Provider Identifier [NPI]: | 1770575136 |
| Last Name Of The Provider | WEISENBERG |
| First Name Of The Provider | ELLIOT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1775 DEMPSTER ST |
| Street Address 2 Of The Provider | C/O PATHOLOGY DEPARTMENT |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 60068 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 1165 |
| Number Of Medicare Beneficiaries | 447 |
| Total Submitted Charge Amount | 259071 |
| Total Medicare Allowed Amount | 42684.03 |
| Total Medicare Payment Amount | 32539.09 |
| Total Medicare Standardized Payment Amount | 24053.06 |
| 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 | 27 |
| Number Of Medical Services | 1165 |
| Number Of Medicare Beneficiaries With Medical Services | 447 |
| Total Medical Submitted Charge Amount | 259071 |
| Total Medical Medicare Allowed Amount | 42684.03 |
| Total Medical Medicare Payment Amount | 32539.09 |
| Total Medical Medicare Standardized Payment Amount | 24053.06 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 94 |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 114 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 269 |
| Number Of Male Beneficiaries | 178 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| Number Of Black or African American Beneficiaries | 137 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 106 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 261 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 186 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5795 |