| National Provider Identifier [NPI]: | 1619943586 |
| Last Name Of The Provider | LAVINE |
| First Name Of The Provider | MICHAEL |
| 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 | 430 PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GLEN ELLYN |
| Zip Code Of The Provider | 601374464 |
| 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 | 58 |
| Number Of Services | 4272 |
| Number Of Medicare Beneficiaries | 1910 |
| Total Submitted Charge Amount | 915428 |
| Total Medicare Allowed Amount | 328409.63 |
| Total Medicare Payment Amount | 287730.13 |
| Total Medicare Standardized Payment Amount | 269471.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 467 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 936 |
| Total Drug Medicare AllowedAmount | 87.94 |
| Total Drug Medicare PaymentAmount | 68.95 |
| Total Drug Medicare Standardized Payment Amount | 68.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 3805 |
| Number Of Medicare Beneficiaries With Medical Services | 1910 |
| Total Medical Submitted Charge Amount | 914492 |
| Total Medical Medicare Allowed Amount | 328321.69 |
| Total Medical Medicare Payment Amount | 287661.18 |
| Total Medical Medicare Standardized Payment Amount | 269402.39 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 116 |
| Number Of Beneficiaries Age 65 to 74 | 1225 |
| Number Of Beneficiaries Age 75 to 84 | 486 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 1852 |
| Number Of Male Beneficiaries | 58 |
| Number Of Non Hispanic White Beneficiaries | 1686 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | 70 |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1780 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7347 |