National Provider Identifier [NPI]: |
1598704728 |
Last Name Of The Provider |
LEBO |
First Name Of The Provider |
NADINE |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3249 OAK PARK AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
BERWYN |
Zip Code Of The Provider |
604023429 |
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 |
110 |
Number Of Services |
1797 |
Number Of Medicare Beneficiaries |
1348 |
Total Submitted Charge Amount |
191063 |
Total Medicare Allowed Amount |
37731.95 |
Total Medicare Payment Amount |
27193.79 |
Total Medicare Standardized Payment Amount |
25537.5 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
110 |
Number Of Medical Services |
1797 |
Number Of Medicare Beneficiaries With Medical Services |
1348 |
Total Medical Submitted Charge Amount |
191063 |
Total Medical Medicare Allowed Amount |
37731.95 |
Total Medical Medicare Payment Amount |
27193.79 |
Total Medical Medicare Standardized Payment Amount |
25537.5 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
237 |
Number Of Beneficiaries Age 65 to 74 |
454 |
Number Of Beneficiaries Age 75 to 84 |
393 |
Number Of Beneficiaries Age Greater 84 |
264 |
Number Of Female Beneficiaries |
838 |
Number Of Male Beneficiaries |
510 |
Number Of Non Hispanic White Beneficiaries |
816 |
Number Of Black or African American Beneficiaries |
104 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
407 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
824 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
524 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
24 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
37 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
55 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
1.7919 |