| National Provider Identifier [NPI]: | 1780747600 |
| Last Name Of The Provider | KUPPUSWAMI |
| First Name Of The Provider | SIVARAJA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3815 HIGHLAND AVE |
| Street Address 2 Of The Provider | GOOD SAMARITAN HOSPITAL |
| City Of The Provider | DOWNERS GROVE |
| Zip Code Of The Provider | 605151500 |
| 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 | 167 |
| Number Of Services | 4808 |
| Number Of Medicare Beneficiaries | 2847 |
| Total Submitted Charge Amount | 700613 |
| Total Medicare Allowed Amount | 154250.73 |
| Total Medicare Payment Amount | 119875.15 |
| Total Medicare Standardized Payment Amount | 114789.44 |
| 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 | 167 |
| Number Of Medical Services | 4808 |
| Number Of Medicare Beneficiaries With Medical Services | 2847 |
| Total Medical Submitted Charge Amount | 700613 |
| Total Medical Medicare Allowed Amount | 154250.73 |
| Total Medical Medicare Payment Amount | 119875.15 |
| Total Medical Medicare Standardized Payment Amount | 114789.44 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 261 |
| Number Of Beneficiaries Age 65 to 74 | 902 |
| Number Of Beneficiaries Age 75 to 84 | 903 |
| Number Of Beneficiaries Age Greater 84 | 781 |
| Number Of Female Beneficiaries | 1709 |
| Number Of Male Beneficiaries | 1138 |
| Number Of Non Hispanic White Beneficiaries | 2442 |
| Number Of Black or African American Beneficiaries | 102 |
| Number Of AsianPacific Islander Beneficiaries | 145 |
| Number Of Hispanic Beneficiaries | 92 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 438 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8686 |