| National Provider Identifier [NPI]: | 1952308587 |
| Last Name Of The Provider | NISSEN |
| First Name Of The Provider | ROGER |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 880 W CENTRAL RD |
| Street Address 2 Of The Provider | SUITE 7100 |
| City Of The Provider | ARLINGTON HTS |
| Zip Code Of The Provider | 600052355 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 3736 |
| Number Of Medicare Beneficiaries | 1109 |
| Total Submitted Charge Amount | 697611 |
| Total Medicare Allowed Amount | 267397.08 |
| Total Medicare Payment Amount | 195986.52 |
| Total Medicare Standardized Payment Amount | 180686.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 129 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 17153 |
| Total Drug Medicare AllowedAmount | 6791.04 |
| Total Drug Medicare PaymentAmount | 5157.74 |
| Total Drug Medicare Standardized Payment Amount | 5157.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 3607 |
| Number Of Medicare Beneficiaries With Medical Services | 1109 |
| Total Medical Submitted Charge Amount | 680458 |
| Total Medical Medicare Allowed Amount | 260606.04 |
| Total Medical Medicare Payment Amount | 190828.78 |
| Total Medical Medicare Standardized Payment Amount | 175528.74 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 282 |
| Number Of Beneficiaries Age 75 to 84 | 422 |
| Number Of Beneficiaries Age Greater 84 | 370 |
| Number Of Female Beneficiaries | 539 |
| Number Of Male Beneficiaries | 570 |
| Number Of Non Hispanic White Beneficiaries | 1044 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 990 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 40 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.609 |