National Provider Identifier [NPI]: |
1083625966 |
Last Name Of The Provider |
SENDER |
First Name Of The Provider |
IRA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
155 E BRUSH HILL RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
ELMHURST |
Zip Code Of The Provider |
601265658 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
891 |
Number Of Medicare Beneficiaries |
798 |
Total Submitted Charge Amount |
570771 |
Total Medicare Allowed Amount |
116931.81 |
Total Medicare Payment Amount |
91270.36 |
Total Medicare Standardized Payment Amount |
86030.71 |
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 |
28 |
Number Of Medical Services |
891 |
Number Of Medicare Beneficiaries With Medical Services |
798 |
Total Medical Submitted Charge Amount |
570771 |
Total Medical Medicare Allowed Amount |
116931.81 |
Total Medical Medicare Payment Amount |
91270.36 |
Total Medical Medicare Standardized Payment Amount |
86030.71 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
117 |
Number Of Beneficiaries Age 65 to 74 |
216 |
Number Of Beneficiaries Age 75 to 84 |
222 |
Number Of Beneficiaries Age Greater 84 |
243 |
Number Of Female Beneficiaries |
502 |
Number Of Male Beneficiaries |
296 |
Number Of Non Hispanic White Beneficiaries |
648 |
Number Of Black or African American Beneficiaries |
79 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
49 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
614 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
184 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
27 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
37 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
29 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
17 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
60 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.9372 |