| National Provider Identifier [NPI]: | 1750480356 |
| Last Name Of The Provider | ROTH |
| First Name Of The Provider | ADELE |
| 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 | 2900 FRANK SCOTT PKWY W |
| Street Address 2 Of The Provider | SUITE 980 |
| City Of The Provider | BELLEVILLE |
| Zip Code Of The Provider | 622235000 |
| 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 | 56 |
| Number Of Services | 2147 |
| Number Of Medicare Beneficiaries | 460 |
| Total Submitted Charge Amount | 139261.92 |
| Total Medicare Allowed Amount | 117753.39 |
| Total Medicare Payment Amount | 76001.65 |
| Total Medicare Standardized Payment Amount | 78523.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 285 |
| Number Of Medicare Beneficiaries With Drug Services | 133 |
| Total Drug Submitted ChargeAmount | 6446 |
| Total Drug Medicare AllowedAmount | 3268.3 |
| Total Drug Medicare PaymentAmount | 3058.34 |
| Total Drug Medicare Standardized Payment Amount | 3058.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 1862 |
| Number Of Medicare Beneficiaries With Medical Services | 460 |
| Total Medical Submitted Charge Amount | 132815.92 |
| Total Medical Medicare Allowed Amount | 114485.09 |
| Total Medical Medicare Payment Amount | 72943.31 |
| Total Medical Medicare Standardized Payment Amount | 75464.67 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 248 |
| Number Of Beneficiaries Age 75 to 84 | 139 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 335 |
| Number Of Male Beneficiaries | 125 |
| Number Of Non Hispanic White Beneficiaries | 438 |
| Number Of Black or African American Beneficiaries | |
| 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 | 441 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9592 |