| National Provider Identifier [NPI]: | 1548288145 |
| Last Name Of The Provider | JENNEWEIN |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3050 MONTVALE DR STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627046924 |
| 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 | 155 |
| Number Of Services | 4977 |
| Number Of Medicare Beneficiaries | 3377 |
| Total Submitted Charge Amount | 880288.3 |
| Total Medicare Allowed Amount | 153177.23 |
| Total Medicare Payment Amount | 118627.31 |
| Total Medicare Standardized Payment Amount | 120046.04 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 685 |
| Number Of Beneficiaries Age 65 to 74 | 1191 |
| Number Of Beneficiaries Age 75 to 84 | 904 |
| Number Of Beneficiaries Age Greater 84 | 597 |
| Number Of Female Beneficiaries | 2000 |
| Number Of Male Beneficiaries | 1377 |
| Number Of Non Hispanic White Beneficiaries | 2786 |
| Number Of Black or African American Beneficiaries | 526 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2289 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1088 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.802 |