| National Provider Identifier [NPI]: | 1194702092 |
| Last Name Of The Provider | RICHARDSON |
| First Name Of The Provider | FRED |
| 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 | 736 W 95TH ST |
| Street Address 2 Of The Provider | HALSTED MEDICAL CENTER |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606281063 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 693 |
| Number Of Medicare Beneficiaries | 265 |
| Total Submitted Charge Amount | 114153.67 |
| Total Medicare Allowed Amount | 79060.96 |
| Total Medicare Payment Amount | 54922.11 |
| Total Medicare Standardized Payment Amount | 51450.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 14 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 273 |
| Total Drug Medicare AllowedAmount | 195.34 |
| Total Drug Medicare PaymentAmount | 191.46 |
| Total Drug Medicare Standardized Payment Amount | 191.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 679 |
| Number Of Medicare Beneficiaries With Medical Services | 265 |
| Total Medical Submitted Charge Amount | 113880.67 |
| Total Medical Medicare Allowed Amount | 78865.62 |
| Total Medical Medicare Payment Amount | 54730.65 |
| Total Medical Medicare Standardized Payment Amount | 51258.81 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 163 |
| Number Of Male Beneficiaries | 102 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 164 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 190 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 36 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7494 |