| National Provider Identifier [NPI]: | 1154454635 |
| Last Name Of The Provider | DOMB |
| First Name Of The Provider | BENJAMIN |
| 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 | 1010 EXECUTIVE DR |
| Street Address 2 Of The Provider | SUITE 250 |
| City Of The Provider | WESTMONT |
| Zip Code Of The Provider | 605596135 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 2349 |
| Number Of Medicare Beneficiaries | 239 |
| Total Submitted Charge Amount | 1227921.45 |
| Total Medicare Allowed Amount | 177139.42 |
| Total Medicare Payment Amount | 132981.34 |
| Total Medicare Standardized Payment Amount | 125379.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 901 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 17047.5 |
| Total Drug Medicare AllowedAmount | 6082.38 |
| Total Drug Medicare PaymentAmount | 4719.22 |
| Total Drug Medicare Standardized Payment Amount | 4719.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 1448 |
| Number Of Medicare Beneficiaries With Medical Services | 239 |
| Total Medical Submitted Charge Amount | 1210873.95 |
| Total Medical Medicare Allowed Amount | 171057.04 |
| Total Medical Medicare Payment Amount | 128262.12 |
| Total Medical Medicare Standardized Payment Amount | 120660.58 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 140 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 142 |
| Number Of Male Beneficiaries | 97 |
| Number Of Non Hispanic White Beneficiaries | 221 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7971 |