| National Provider Identifier [NPI]: | 1013968239 |
| Last Name Of The Provider | SIA |
| First Name Of The Provider | IMELDA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 113 W LAKE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLOOMINGDALE |
| Zip Code Of The Provider | 601081006 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 2006 |
| Number Of Medicare Beneficiaries | 415 |
| Total Submitted Charge Amount | 203777 |
| Total Medicare Allowed Amount | 153752.91 |
| Total Medicare Payment Amount | 110300.33 |
| Total Medicare Standardized Payment Amount | 108869.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 187 |
| Number Of Medicare Beneficiaries With Drug Services | 134 |
| Total Drug Submitted ChargeAmount | 6814 |
| Total Drug Medicare AllowedAmount | 4617.84 |
| Total Drug Medicare PaymentAmount | 4499.73 |
| Total Drug Medicare Standardized Payment Amount | 4499.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 1819 |
| Number Of Medicare Beneficiaries With Medical Services | 415 |
| Total Medical Submitted Charge Amount | 196963 |
| Total Medical Medicare Allowed Amount | 149135.07 |
| Total Medical Medicare Payment Amount | 105800.6 |
| Total Medical Medicare Standardized Payment Amount | 104369.28 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 160 |
| Number Of Beneficiaries Age 75 to 84 | 133 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 285 |
| Number Of Male Beneficiaries | 130 |
| Number Of Non Hispanic White Beneficiaries | 199 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 110 |
| Number Of Hispanic Beneficiaries | 76 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 253 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 66 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2198 |