| National Provider Identifier [NPI]: | 1437187366 |
| Last Name Of The Provider | JOHANEK |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2300 N CHILDRENS PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606143363 |
| 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 | 190 |
| Number Of Services | 7203 |
| Number Of Medicare Beneficiaries | 4255 |
| Total Submitted Charge Amount | 988777 |
| Total Medicare Allowed Amount | 251318.83 |
| Total Medicare Payment Amount | 184958.91 |
| Total Medicare Standardized Payment Amount | 178695.37 |
| 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 | 190 |
| Number Of Medical Services | 7203 |
| Number Of Medicare Beneficiaries With Medical Services | 4255 |
| Total Medical Submitted Charge Amount | 988777 |
| Total Medical Medicare Allowed Amount | 251318.83 |
| Total Medical Medicare Payment Amount | 184958.91 |
| Total Medical Medicare Standardized Payment Amount | 178695.37 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 751 |
| Number Of Beneficiaries Age 65 to 74 | 1398 |
| Number Of Beneficiaries Age 75 to 84 | 1255 |
| Number Of Beneficiaries Age Greater 84 | 851 |
| Number Of Female Beneficiaries | 2607 |
| Number Of Male Beneficiaries | 1648 |
| Number Of Non Hispanic White Beneficiaries | 3516 |
| Number Of Black or African American Beneficiaries | 450 |
| Number Of AsianPacific Islander Beneficiaries | 31 |
| Number Of Hispanic Beneficiaries | 227 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3226 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1029 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9159 |