| National Provider Identifier [NPI]: | 1790785848 |
| Last Name Of The Provider | DOMBROWSKI |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1420 RENAISSANCE DR |
| Street Address 2 Of The Provider | SUITE #307 |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 600681330 |
| 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 | 143 |
| Number Of Services | 4220 |
| Number Of Medicare Beneficiaries | 2773 |
| Total Submitted Charge Amount | 672262 |
| Total Medicare Allowed Amount | 135294.11 |
| Total Medicare Payment Amount | 103786.1 |
| Total Medicare Standardized Payment Amount | 98045.56 |
| 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 | 143 |
| Number Of Medical Services | 4220 |
| Number Of Medicare Beneficiaries With Medical Services | 2773 |
| Total Medical Submitted Charge Amount | 672262 |
| Total Medical Medicare Allowed Amount | 135294.11 |
| Total Medical Medicare Payment Amount | 103786.1 |
| Total Medical Medicare Standardized Payment Amount | 98045.56 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 255 |
| Number Of Beneficiaries Age 65 to 74 | 913 |
| Number Of Beneficiaries Age 75 to 84 | 963 |
| Number Of Beneficiaries Age Greater 84 | 642 |
| Number Of Female Beneficiaries | 1726 |
| Number Of Male Beneficiaries | 1047 |
| Number Of Non Hispanic White Beneficiaries | 2408 |
| Number Of Black or African American Beneficiaries | 60 |
| Number Of AsianPacific Islander Beneficiaries | 146 |
| Number Of Hispanic Beneficiaries | 110 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2214 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 559 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7647 |