| National Provider Identifier [NPI]: | 1720061526 |
| Last Name Of The Provider | KALIS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 120 OAK BROOK CENTER MALL |
| Street Address 2 Of The Provider | SUITE 410 |
| City Of The Provider | OAK BROOK |
| Zip Code Of The Provider | 605231806 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 5590 |
| Number Of Medicare Beneficiaries | 1000 |
| Total Submitted Charge Amount | 581323 |
| Total Medicare Allowed Amount | 295638.49 |
| Total Medicare Payment Amount | 214049.26 |
| Total Medicare Standardized Payment Amount | 198727.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 4208 |
| Total Drug Medicare AllowedAmount | 2499.83 |
| Total Drug Medicare PaymentAmount | 1952.29 |
| Total Drug Medicare Standardized Payment Amount | 1952.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 5556 |
| Number Of Medicare Beneficiaries With Medical Services | 1000 |
| Total Medical Submitted Charge Amount | 577115 |
| Total Medical Medicare Allowed Amount | 293138.66 |
| Total Medical Medicare Payment Amount | 212096.97 |
| Total Medical Medicare Standardized Payment Amount | 196774.89 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 470 |
| Number Of Beneficiaries Age 75 to 84 | 349 |
| Number Of Beneficiaries Age Greater 84 | 143 |
| Number Of Female Beneficiaries | 430 |
| Number Of Male Beneficiaries | 570 |
| Number Of Non Hispanic White Beneficiaries | 962 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 962 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.895 |