| National Provider Identifier [NPI]: | 1437184736 |
| Last Name Of The Provider | HENDRICKSON |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 602 W. UNIVERSITY AVENUE |
| Street Address 2 Of The Provider | RADIOLOGY |
| City Of The Provider | URBANA |
| Zip Code Of The Provider | 61801 |
| 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 | 137 |
| Number Of Services | 4108 |
| Number Of Medicare Beneficiaries | 2868 |
| Total Submitted Charge Amount | 837787 |
| Total Medicare Allowed Amount | 91872.51 |
| Total Medicare Payment Amount | 66735.48 |
| Total Medicare Standardized Payment Amount | 68216.91 |
| 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 | 137 |
| Number Of Medical Services | 4108 |
| Number Of Medicare Beneficiaries With Medical Services | 2868 |
| Total Medical Submitted Charge Amount | 837787 |
| Total Medical Medicare Allowed Amount | 91872.51 |
| Total Medical Medicare Payment Amount | 66735.48 |
| Total Medical Medicare Standardized Payment Amount | 68216.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 584 |
| Number Of Beneficiaries Age 65 to 74 | 1050 |
| Number Of Beneficiaries Age 75 to 84 | 806 |
| Number Of Beneficiaries Age Greater 84 | 428 |
| Number Of Female Beneficiaries | 1728 |
| Number Of Male Beneficiaries | 1140 |
| Number Of Non Hispanic White Beneficiaries | 2553 |
| Number Of Black or African American Beneficiaries | 219 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2111 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 757 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4785 |