| National Provider Identifier [NPI]: | 1487631354 |
| Last Name Of The Provider | LIM-DUNHAM |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2106 S FIRST AVE |
| Street Address 2 Of The Provider | 101 1740 LOYOLA UNIVERSITY MEDICAL CENTER |
| 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 | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 99 |
| Number Of Services | 4025 |
| Number Of Medicare Beneficiaries | 2206 |
| Total Submitted Charge Amount | 407511 |
| Total Medicare Allowed Amount | 75385.86 |
| Total Medicare Payment Amount | 56694.22 |
| Total Medicare Standardized Payment Amount | 51490.83 |
| 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 | 99 |
| Number Of Medical Services | 4025 |
| Number Of Medicare Beneficiaries With Medical Services | 2206 |
| Total Medical Submitted Charge Amount | 407511 |
| Total Medical Medicare Allowed Amount | 75385.86 |
| Total Medical Medicare Payment Amount | 56694.22 |
| Total Medical Medicare Standardized Payment Amount | 51490.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 443 |
| Number Of Beneficiaries Age 65 to 74 | 889 |
| Number Of Beneficiaries Age 75 to 84 | 589 |
| Number Of Beneficiaries Age Greater 84 | 285 |
| Number Of Female Beneficiaries | 1101 |
| Number Of Male Beneficiaries | 1105 |
| Number Of Non Hispanic White Beneficiaries | 1554 |
| Number Of Black or African American Beneficiaries | 392 |
| Number Of AsianPacific Islander Beneficiaries | 51 |
| Number Of Hispanic Beneficiaries | 185 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1620 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 586 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.2102 |