| National Provider Identifier [NPI]: | 1356632475 |
| Last Name Of The Provider | KLOCH |
| First Name Of The Provider | MAGDALENA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MS, ANP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2550 HAUSER ROSS DR |
| Street Address 2 Of The Provider | SUITE 325 |
| City Of The Provider | SYCAMORE |
| Zip Code Of The Provider | 601783149 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 915 |
| Number Of Medicare Beneficiaries | 291 |
| Total Submitted Charge Amount | 121304 |
| Total Medicare Allowed Amount | 62619.57 |
| Total Medicare Payment Amount | 48159.67 |
| Total Medicare Standardized Payment Amount | 58116.33 |
| 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 | 16 |
| Number Of Medical Services | 915 |
| Number Of Medicare Beneficiaries With Medical Services | 291 |
| Total Medical Submitted Charge Amount | 121304 |
| Total Medical Medicare Allowed Amount | 62619.57 |
| Total Medical Medicare Payment Amount | 48159.67 |
| Total Medical Medicare Standardized Payment Amount | 58116.33 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 97 |
| Number Of Beneficiaries Age 75 to 84 | 85 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 157 |
| Number Of Male Beneficiaries | 134 |
| Number Of Non Hispanic White Beneficiaries | 262 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | 101 |
| Percent Of With Atrial Fibrillation | 54 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 58 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.8425 |