| National Provider Identifier [NPI]: | 1609890979 |
| Last Name Of The Provider | GOLDSTEIN |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1875 DEMPSTER ST |
| Street Address 2 Of The Provider | SUITE 555 |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 600681186 |
| 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 | 5426 |
| Number Of Medicare Beneficiaries | 2117 |
| Total Submitted Charge Amount | 1037114.5 |
| Total Medicare Allowed Amount | 425327.6 |
| Total Medicare Payment Amount | 323429.18 |
| Total Medicare Standardized Payment Amount | 308270.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 251 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 17725.5 |
| Total Drug Medicare AllowedAmount | 11926.4 |
| Total Drug Medicare PaymentAmount | 9286.36 |
| Total Drug Medicare Standardized Payment Amount | 9286.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 5175 |
| Number Of Medicare Beneficiaries With Medical Services | 2117 |
| Total Medical Submitted Charge Amount | 1019389 |
| Total Medical Medicare Allowed Amount | 413401.2 |
| Total Medical Medicare Payment Amount | 314142.82 |
| Total Medical Medicare Standardized Payment Amount | 298984.06 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 112 |
| Number Of Beneficiaries Age 65 to 74 | 615 |
| Number Of Beneficiaries Age 75 to 84 | 787 |
| Number Of Beneficiaries Age Greater 84 | 603 |
| Number Of Female Beneficiaries | 1113 |
| Number Of Male Beneficiaries | 1004 |
| Number Of Non Hispanic White Beneficiaries | 1865 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 112 |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1748 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 369 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7523 |