| National Provider Identifier [NPI]: | 1730349028 |
| Last Name Of The Provider | BOUMENDJEL |
| First Name Of The Provider | REDOUANE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 840 S WOOD ST |
| Street Address 2 Of The Provider | SUITE 130 CSN |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 60612 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 4604 |
| Number Of Medicare Beneficiaries | 1381 |
| Total Submitted Charge Amount | 1256908.9 |
| Total Medicare Allowed Amount | 164473.21 |
| Total Medicare Payment Amount | 128087.93 |
| Total Medicare Standardized Payment Amount | 97638.36 |
| 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 | 31 |
| Number Of Medical Services | 4604 |
| Number Of Medicare Beneficiaries With Medical Services | 1381 |
| Total Medical Submitted Charge Amount | 1256908.9 |
| Total Medical Medicare Allowed Amount | 164473.21 |
| Total Medical Medicare Payment Amount | 128087.93 |
| Total Medical Medicare Standardized Payment Amount | 97638.36 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 127 |
| Number Of Beneficiaries Age 65 to 74 | 591 |
| Number Of Beneficiaries Age 75 to 84 | 466 |
| Number Of Beneficiaries Age Greater 84 | 197 |
| Number Of Female Beneficiaries | 710 |
| Number Of Male Beneficiaries | 671 |
| Number Of Non Hispanic White Beneficiaries | 1206 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | 80 |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1178 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 203 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4735 |