| National Provider Identifier [NPI]: | 1902915507 |
| Last Name Of The Provider | BENNIN |
| First Name Of The Provider | BRUCE |
| 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 | 400 SKOKIE BLVD |
| Street Address 2 Of The Provider | SUITE 475 |
| City Of The Provider | NORTHBROOK |
| Zip Code Of The Provider | 600626930 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 6095 |
| Number Of Medicare Beneficiaries | 1738 |
| Total Submitted Charge Amount | 409183 |
| Total Medicare Allowed Amount | 376077.53 |
| Total Medicare Payment Amount | 270573.92 |
| Total Medicare Standardized Payment Amount | 249452.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 2575 |
| Total Drug Medicare AllowedAmount | 2445.5 |
| Total Drug Medicare PaymentAmount | 1903.71 |
| Total Drug Medicare Standardized Payment Amount | 1903.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 6084 |
| Number Of Medicare Beneficiaries With Medical Services | 1738 |
| Total Medical Submitted Charge Amount | 406608 |
| Total Medical Medicare Allowed Amount | 373632.03 |
| Total Medical Medicare Payment Amount | 268670.21 |
| Total Medical Medicare Standardized Payment Amount | 247548.94 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 769 |
| Number Of Beneficiaries Age 75 to 84 | 617 |
| Number Of Beneficiaries Age Greater 84 | 319 |
| Number Of Female Beneficiaries | 907 |
| Number Of Male Beneficiaries | 831 |
| Number Of Non Hispanic White Beneficiaries | 1691 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1708 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9706 |