| National Provider Identifier [NPI]: | 1831353788 |
| Last Name Of The Provider | SPACKEY |
| First Name Of The Provider | JUSTIN |
| 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 FIRST AVE |
| Street Address 2 Of The Provider | |
| 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 | 174 |
| Number Of Services | 7661 |
| Number Of Medicare Beneficiaries | 4799 |
| Total Submitted Charge Amount | 1140133 |
| Total Medicare Allowed Amount | 268634.97 |
| Total Medicare Payment Amount | 201481.23 |
| Total Medicare Standardized Payment Amount | 204942.39 |
| 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 | 174 |
| Number Of Medical Services | 7661 |
| Number Of Medicare Beneficiaries With Medical Services | 4799 |
| Total Medical Submitted Charge Amount | 1140133 |
| Total Medical Medicare Allowed Amount | 268634.97 |
| Total Medical Medicare Payment Amount | 201481.23 |
| Total Medical Medicare Standardized Payment Amount | 204942.39 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 851 |
| Number Of Beneficiaries Age 65 to 74 | 1621 |
| Number Of Beneficiaries Age 75 to 84 | 1453 |
| Number Of Beneficiaries Age Greater 84 | 874 |
| Number Of Female Beneficiaries | 2844 |
| Number Of Male Beneficiaries | 1955 |
| Number Of Non Hispanic White Beneficiaries | 3518 |
| Number Of Black or African American Beneficiaries | 671 |
| Number Of AsianPacific Islander Beneficiaries | 35 |
| Number Of Hispanic Beneficiaries | 551 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3717 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1082 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.9643 |