| National Provider Identifier [NPI]: | 1598767295 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | PROVENA MERCY MEDICAL CENTER / RADIOLOGY DEPARTMENT |
| Street Address 2 Of The Provider | 1325 NORTH HIGHLAND AVENUE |
| City Of The Provider | AURORA |
| Zip Code Of The Provider | 60506 |
| 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 | 178 |
| Number Of Services | 13542 |
| Number Of Medicare Beneficiaries | 2563 |
| Total Submitted Charge Amount | 965559.85 |
| Total Medicare Allowed Amount | 228406.04 |
| Total Medicare Payment Amount | 174878.44 |
| Total Medicare Standardized Payment Amount | 170407.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9478 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 11616 |
| Total Drug Medicare AllowedAmount | 2521.07 |
| Total Drug Medicare PaymentAmount | 1774.39 |
| Total Drug Medicare Standardized Payment Amount | 1774.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 175 |
| Number Of Medical Services | 4064 |
| Number Of Medicare Beneficiaries With Medical Services | 2563 |
| Total Medical Submitted Charge Amount | 953943.85 |
| Total Medical Medicare Allowed Amount | 225884.97 |
| Total Medical Medicare Payment Amount | 173104.05 |
| Total Medical Medicare Standardized Payment Amount | 168633.28 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 405 |
| Number Of Beneficiaries Age 65 to 74 | 1071 |
| Number Of Beneficiaries Age 75 to 84 | 701 |
| Number Of Beneficiaries Age Greater 84 | 386 |
| Number Of Female Beneficiaries | 1569 |
| Number Of Male Beneficiaries | 994 |
| Number Of Non Hispanic White Beneficiaries | 2126 |
| Number Of Black or African American Beneficiaries | 172 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 224 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1924 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 639 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6005 |