| National Provider Identifier [NPI]: | 1437121472 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | GRACE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 INGALLS DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARVEY |
| Zip Code Of The Provider | 604263558 |
| 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 | 207 |
| Number Of Services | 5254 |
| Number Of Medicare Beneficiaries | 3432 |
| Total Submitted Charge Amount | 975773.5 |
| Total Medicare Allowed Amount | 146060.2 |
| Total Medicare Payment Amount | 117614.73 |
| Total Medicare Standardized Payment Amount | 112812 |
| 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 | 207 |
| Number Of Medical Services | 5254 |
| Number Of Medicare Beneficiaries With Medical Services | 3432 |
| Total Medical Submitted Charge Amount | 975773.5 |
| Total Medical Medicare Allowed Amount | 146060.2 |
| Total Medical Medicare Payment Amount | 117614.73 |
| Total Medical Medicare Standardized Payment Amount | 112812 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 584 |
| Number Of Beneficiaries Age 65 to 74 | 1342 |
| Number Of Beneficiaries Age 75 to 84 | 1005 |
| Number Of Beneficiaries Age Greater 84 | 501 |
| Number Of Female Beneficiaries | 2411 |
| Number Of Male Beneficiaries | 1021 |
| Number Of Non Hispanic White Beneficiaries | 1789 |
| Number Of Black or African American Beneficiaries | 1430 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 165 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2446 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 986 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7568 |