| National Provider Identifier [NPI]: | 1982779237 |
| Last Name Of The Provider | DEMAERTELAERE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 222 COLORADO AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FRANKFORT |
| Zip Code Of The Provider | 604231334 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 6274 |
| Number Of Medicare Beneficiaries | 670 |
| Total Submitted Charge Amount | 446238.72 |
| Total Medicare Allowed Amount | 251102.09 |
| Total Medicare Payment Amount | 181718.11 |
| Total Medicare Standardized Payment Amount | 174592.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1426 |
| Number Of Medicare Beneficiaries With Drug Services | 159 |
| Total Drug Submitted ChargeAmount | 76373.6 |
| Total Drug Medicare AllowedAmount | 24114.02 |
| Total Drug Medicare PaymentAmount | 20013.92 |
| Total Drug Medicare Standardized Payment Amount | 20013.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 4848 |
| Number Of Medicare Beneficiaries With Medical Services | 669 |
| Total Medical Submitted Charge Amount | 369865.12 |
| Total Medical Medicare Allowed Amount | 226988.07 |
| Total Medical Medicare Payment Amount | 161704.19 |
| Total Medical Medicare Standardized Payment Amount | 154578.43 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 330 |
| Number Of Beneficiaries Age 75 to 84 | 203 |
| Number Of Beneficiaries Age Greater 84 | 102 |
| Number Of Female Beneficiaries | 361 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 651 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 643 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0413 |