| National Provider Identifier [NPI]: | 1407812050 |
| Last Name Of The Provider | KIESO |
| First Name Of The Provider | HASSAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3800 W 203RD ST |
| Street Address 2 Of The Provider | SUITE 204 |
| City Of The Provider | OLYMPIA FIELDS |
| Zip Code Of The Provider | 604611184 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 7520 |
| Number Of Medicare Beneficiaries | 2383 |
| Total Submitted Charge Amount | 620901.95 |
| Total Medicare Allowed Amount | 583751.48 |
| Total Medicare Payment Amount | 439196.62 |
| Total Medicare Standardized Payment Amount | 414763.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 780.04 |
| Total Drug Medicare AllowedAmount | 779.92 |
| Total Drug Medicare PaymentAmount | 764.28 |
| Total Drug Medicare Standardized Payment Amount | 764.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 109 |
| Number Of Medical Services | 7494 |
| Number Of Medicare Beneficiaries With Medical Services | 2383 |
| Total Medical Submitted Charge Amount | 620121.91 |
| Total Medical Medicare Allowed Amount | 582971.56 |
| Total Medical Medicare Payment Amount | 438432.34 |
| Total Medical Medicare Standardized Payment Amount | 413999.48 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 313 |
| Number Of Beneficiaries Age 65 to 74 | 843 |
| Number Of Beneficiaries Age 75 to 84 | 771 |
| Number Of Beneficiaries Age Greater 84 | 456 |
| Number Of Female Beneficiaries | 1372 |
| Number Of Male Beneficiaries | 1011 |
| Number Of Non Hispanic White Beneficiaries | 1349 |
| Number Of Black or African American Beneficiaries | 899 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 103 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1770 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 613 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.954 |