| National Provider Identifier [NPI]: | 1033173125 |
| Last Name Of The Provider | ERICKSON |
| First Name Of The Provider | KURT |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2338 NEW ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLUE ISLAND |
| Zip Code Of The Provider | 604062402 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 17142 |
| Number Of Medicare Beneficiaries | 2609 |
| Total Submitted Charge Amount | 1972216 |
| Total Medicare Allowed Amount | 583131.6 |
| Total Medicare Payment Amount | 442215.44 |
| Total Medicare Standardized Payment Amount | 416104.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 11818 |
| Number Of Medicare Beneficiaries With Drug Services | 133 |
| Total Drug Submitted ChargeAmount | 15160 |
| Total Drug Medicare AllowedAmount | 3516.38 |
| Total Drug Medicare PaymentAmount | 2748.65 |
| Total Drug Medicare Standardized Payment Amount | 2748.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 5324 |
| Number Of Medicare Beneficiaries With Medical Services | 2609 |
| Total Medical Submitted Charge Amount | 1957056 |
| Total Medical Medicare Allowed Amount | 579615.22 |
| Total Medical Medicare Payment Amount | 439466.79 |
| Total Medical Medicare Standardized Payment Amount | 413356.22 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 283 |
| Number Of Beneficiaries Age 65 to 74 | 888 |
| Number Of Beneficiaries Age 75 to 84 | 933 |
| Number Of Beneficiaries Age Greater 84 | 505 |
| Number Of Female Beneficiaries | 1417 |
| Number Of Male Beneficiaries | 1192 |
| Number Of Non Hispanic White Beneficiaries | 1687 |
| Number Of Black or African American Beneficiaries | 760 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 132 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1996 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 613 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.0675 |