National Provider Identifier [NPI]: |
1588617294 |
Last Name Of The Provider |
JIMENEZ |
First Name Of The Provider |
MATTHEW |
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 |
9000 WAUKEGAN RD |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
MORTON GROVE |
Zip Code Of The Provider |
600532111 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
173 |
Number Of Services |
5281 |
Number Of Medicare Beneficiaries |
718 |
Total Submitted Charge Amount |
1952197 |
Total Medicare Allowed Amount |
646828.92 |
Total Medicare Payment Amount |
493299.25 |
Total Medicare Standardized Payment Amount |
444249.26 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
812 |
Number Of Medicare Beneficiaries With Drug Services |
194 |
Total Drug Submitted ChargeAmount |
104168 |
Total Drug Medicare AllowedAmount |
77296.28 |
Total Drug Medicare PaymentAmount |
60338.43 |
Total Drug Medicare Standardized Payment Amount |
60338.43 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
167 |
Number Of Medical Services |
4469 |
Number Of Medicare Beneficiaries With Medical Services |
718 |
Total Medical Submitted Charge Amount |
1848029 |
Total Medical Medicare Allowed Amount |
569532.64 |
Total Medical Medicare Payment Amount |
432960.82 |
Total Medical Medicare Standardized Payment Amount |
383910.83 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
68 |
Number Of Beneficiaries Age 65 to 74 |
277 |
Number Of Beneficiaries Age 75 to 84 |
229 |
Number Of Beneficiaries Age Greater 84 |
144 |
Number Of Female Beneficiaries |
456 |
Number Of Male Beneficiaries |
262 |
Number Of Non Hispanic White Beneficiaries |
630 |
Number Of Black or African American Beneficiaries |
12 |
Number Of AsianPacific Islander Beneficiaries |
34 |
Number Of Hispanic Beneficiaries |
27 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
15 |
Number Of Beneficiaries With Medicare Only Entitlement |
586 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
132 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
67 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
19 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
74 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.4132 |