| National Provider Identifier [NPI]: | 1912953191 |
| Last Name Of The Provider | URBAN |
| First Name Of The Provider | MARTIN |
| 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 | 3849 N PERRYVILLE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCKFORD |
| Zip Code Of The Provider | 611148080 |
| 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 | 181 |
| Number Of Services | 5026 |
| Number Of Medicare Beneficiaries | 2075 |
| Total Submitted Charge Amount | 741304.81 |
| Total Medicare Allowed Amount | 133839.22 |
| Total Medicare Payment Amount | 103487.08 |
| Total Medicare Standardized Payment Amount | 107695.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1140 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 12171.4 |
| Total Drug Medicare AllowedAmount | 279.9 |
| Total Drug Medicare PaymentAmount | 219.43 |
| Total Drug Medicare Standardized Payment Amount | 219.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 3886 |
| Number Of Medicare Beneficiaries With Medical Services | 2074 |
| Total Medical Submitted Charge Amount | 729133.41 |
| Total Medical Medicare Allowed Amount | 133559.32 |
| Total Medical Medicare Payment Amount | 103267.65 |
| Total Medical Medicare Standardized Payment Amount | 107476.36 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 401 |
| Number Of Beneficiaries Age 65 to 74 | 674 |
| Number Of Beneficiaries Age 75 to 84 | 596 |
| Number Of Beneficiaries Age Greater 84 | 404 |
| Number Of Female Beneficiaries | 1303 |
| Number Of Male Beneficiaries | 772 |
| Number Of Non Hispanic White Beneficiaries | 1894 |
| Number Of Black or African American Beneficiaries | 111 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1487 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 588 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4793 |