| National Provider Identifier [NPI]: | 1992784094 |
| Last Name Of The Provider | PACOLD |
| First Name Of The Provider | IVAN |
| 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 | 2160 S 1ST AVE |
| Street Address 2 Of The Provider | (1950 S. HARLEM AVE., NORTH RIVERSIDE, IL. 60546) |
| City Of The Provider | MAYWOOD |
| Zip Code Of The Provider | 60153 |
| 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 | 34 |
| Number Of Services | 2342 |
| Number Of Medicare Beneficiaries | 1285 |
| Total Submitted Charge Amount | 651352 |
| Total Medicare Allowed Amount | 143937.14 |
| Total Medicare Payment Amount | 107901.84 |
| Total Medicare Standardized Payment Amount | 101844.82 |
| 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 | 34 |
| Number Of Medical Services | 2342 |
| Number Of Medicare Beneficiaries With Medical Services | 1285 |
| Total Medical Submitted Charge Amount | 651352 |
| Total Medical Medicare Allowed Amount | 143937.14 |
| Total Medical Medicare Payment Amount | 107901.84 |
| Total Medical Medicare Standardized Payment Amount | 101844.82 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 133 |
| Number Of Beneficiaries Age 65 to 74 | 404 |
| Number Of Beneficiaries Age 75 to 84 | 445 |
| Number Of Beneficiaries Age Greater 84 | 303 |
| Number Of Female Beneficiaries | 682 |
| Number Of Male Beneficiaries | 603 |
| Number Of Non Hispanic White Beneficiaries | 921 |
| Number Of Black or African American Beneficiaries | 171 |
| Number Of AsianPacific Islander Beneficiaries | 30 |
| Number Of Hispanic Beneficiaries | 148 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 980 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 305 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8144 |