| National Provider Identifier [NPI]: | 1336167287 |
| Last Name Of The Provider | MOLIS |
| First Name Of The Provider | TINA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 W UNIVERSITY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHAMPAIGN |
| Zip Code Of The Provider | 618203909 |
| 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 | 176 |
| Number Of Services | 23808 |
| Number Of Medicare Beneficiaries | 2058 |
| Total Submitted Charge Amount | 3380441.27 |
| Total Medicare Allowed Amount | 422627.17 |
| Total Medicare Payment Amount | 321526.05 |
| Total Medicare Standardized Payment Amount | 349617.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 20084 |
| Number Of Medicare Beneficiaries With Drug Services | 350 |
| Total Drug Submitted ChargeAmount | 58099 |
| Total Drug Medicare AllowedAmount | 9119.64 |
| Total Drug Medicare PaymentAmount | 7061.97 |
| Total Drug Medicare Standardized Payment Amount | 7061.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 169 |
| Number Of Medical Services | 3724 |
| Number Of Medicare Beneficiaries With Medical Services | 2058 |
| Total Medical Submitted Charge Amount | 3322342.27 |
| Total Medical Medicare Allowed Amount | 413507.53 |
| Total Medical Medicare Payment Amount | 314464.08 |
| Total Medical Medicare Standardized Payment Amount | 342555.1 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 355 |
| Number Of Beneficiaries Age 65 to 74 | 852 |
| Number Of Beneficiaries Age 75 to 84 | 631 |
| Number Of Beneficiaries Age Greater 84 | 220 |
| Number Of Female Beneficiaries | 1320 |
| Number Of Male Beneficiaries | 738 |
| Number Of Non Hispanic White Beneficiaries | 1808 |
| Number Of Black or African American Beneficiaries | 195 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1691 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 367 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2571 |