| National Provider Identifier [NPI]: | 1164577102 |
| Last Name Of The Provider | MEMON |
| First Name Of The Provider | MOHAMMED |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 626 BETHANY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DEKALB |
| Zip Code Of The Provider | 601154939 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 2378 |
| Number Of Medicare Beneficiaries | 705 |
| Total Submitted Charge Amount | 459331.5 |
| Total Medicare Allowed Amount | 192168.08 |
| Total Medicare Payment Amount | 146320.94 |
| Total Medicare Standardized Payment Amount | 148304.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1129.5 |
| Total Drug Medicare AllowedAmount | 602.59 |
| Total Drug Medicare PaymentAmount | 575.53 |
| Total Drug Medicare Standardized Payment Amount | 575.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 2340 |
| Number Of Medicare Beneficiaries With Medical Services | 705 |
| Total Medical Submitted Charge Amount | 458202 |
| Total Medical Medicare Allowed Amount | 191565.49 |
| Total Medical Medicare Payment Amount | 145745.41 |
| Total Medical Medicare Standardized Payment Amount | 147729.24 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 253 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 129 |
| Number Of Female Beneficiaries | 376 |
| Number Of Male Beneficiaries | 329 |
| Number Of Non Hispanic White Beneficiaries | 664 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 618 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8036 |