| National Provider Identifier [NPI]: | 1376641241 |
| Last Name Of The Provider | KUSHNER |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 333 N MADISON |
| Street Address 2 Of The Provider | PROVENA ST JOSEPH MEDICAL CENTER |
| City Of The Provider | JOLIET |
| Zip Code Of The Provider | 60435 |
| 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 | 192 |
| Number Of Services | 5278 |
| Number Of Medicare Beneficiaries | 3107 |
| Total Submitted Charge Amount | 597499.75 |
| Total Medicare Allowed Amount | 157059.35 |
| Total Medicare Payment Amount | 120966.14 |
| Total Medicare Standardized Payment Amount | 116805.24 |
| 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 | 192 |
| Number Of Medical Services | 5278 |
| Number Of Medicare Beneficiaries With Medical Services | 3107 |
| Total Medical Submitted Charge Amount | 597499.75 |
| Total Medical Medicare Allowed Amount | 157059.35 |
| Total Medical Medicare Payment Amount | 120966.14 |
| Total Medical Medicare Standardized Payment Amount | 116805.24 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 472 |
| Number Of Beneficiaries Age 65 to 74 | 1124 |
| Number Of Beneficiaries Age 75 to 84 | 908 |
| Number Of Beneficiaries Age Greater 84 | 603 |
| Number Of Female Beneficiaries | 1999 |
| Number Of Male Beneficiaries | 1108 |
| Number Of Non Hispanic White Beneficiaries | 2556 |
| Number Of Black or African American Beneficiaries | 344 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 151 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2392 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 715 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.9069 |