| National Provider Identifier [NPI]: | 1396739298 |
| Last Name Of The Provider | DETJEN |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 534 GREEN BAY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | KENILWORTH |
| Zip Code Of The Provider | 600431801 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Allergy/Immunology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 4284 |
| Number Of Medicare Beneficiaries | 213 |
| Total Submitted Charge Amount | 168902 |
| Total Medicare Allowed Amount | 83834.68 |
| Total Medicare Payment Amount | 62653.12 |
| Total Medicare Standardized Payment Amount | 60359.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 162 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 51510 |
| Total Drug Medicare AllowedAmount | 4725.25 |
| Total Drug Medicare PaymentAmount | 3974.53 |
| Total Drug Medicare Standardized Payment Amount | 3974.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 4122 |
| Number Of Medicare Beneficiaries With Medical Services | 212 |
| Total Medical Submitted Charge Amount | 117392 |
| Total Medical Medicare Allowed Amount | 79109.43 |
| Total Medical Medicare Payment Amount | 58678.59 |
| Total Medical Medicare Standardized Payment Amount | 56384.9 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 83 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 73 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 11 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 38 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8241 |