| National Provider Identifier [NPI]: | 1629005228 |
| Last Name Of The Provider | CHICOINE |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1999 DEMPSTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 600681156 |
| 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 | 69 |
| Number Of Services | 2556 |
| Number Of Medicare Beneficiaries | 614 |
| Total Submitted Charge Amount | 410632 |
| Total Medicare Allowed Amount | 230852.42 |
| Total Medicare Payment Amount | 159711.9 |
| Total Medicare Standardized Payment Amount | 150859.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 297 |
| Number Of Medicare Beneficiaries With Drug Services | 123 |
| Total Drug Submitted ChargeAmount | 8065 |
| Total Drug Medicare AllowedAmount | 5081.05 |
| Total Drug Medicare PaymentAmount | 4970.49 |
| Total Drug Medicare Standardized Payment Amount | 4970.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 2259 |
| Number Of Medicare Beneficiaries With Medical Services | 614 |
| Total Medical Submitted Charge Amount | 402567 |
| Total Medical Medicare Allowed Amount | 225771.37 |
| Total Medical Medicare Payment Amount | 154741.41 |
| Total Medical Medicare Standardized Payment Amount | 145889.24 |
| Average Age Of Beneficiaries | 49 |
| Number Of Beneficiaries Age Less65 | 541 |
| Number Of Beneficiaries Age 65 to 74 | 41 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 287 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 535 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 82 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 532 |
| Percent Of With Atrial Fibrillation | 2 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 21 |
| Percent Of With Hypertension | 17 |
| Percent Of With Ischemic Heart Disease | 9 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8058 |