| National Provider Identifier [NPI]: | 1326143439 |
| Last Name Of The Provider | SPOO |
| First Name Of The Provider | CHARISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1423 CHICAGO RD |
| Street Address 2 Of The Provider | RADIOLOGY DEPARTMENT |
| City Of The Provider | CHICAGO HEIGHTS |
| Zip Code Of The Provider | 604113400 |
| 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 | 194 |
| Number Of Services | 8964 |
| Number Of Medicare Beneficiaries | 5555 |
| Total Submitted Charge Amount | 1051580 |
| Total Medicare Allowed Amount | 243568.45 |
| Total Medicare Payment Amount | 188342.82 |
| Total Medicare Standardized Payment Amount | 195445.89 |
| 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 | 194 |
| Number Of Medical Services | 8964 |
| Number Of Medicare Beneficiaries With Medical Services | 5555 |
| Total Medical Submitted Charge Amount | 1051580 |
| Total Medical Medicare Allowed Amount | 243568.45 |
| Total Medical Medicare Payment Amount | 188342.82 |
| Total Medical Medicare Standardized Payment Amount | 195445.89 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 929 |
| Number Of Beneficiaries Age 65 to 74 | 2255 |
| Number Of Beneficiaries Age 75 to 84 | 1576 |
| Number Of Beneficiaries Age Greater 84 | 795 |
| Number Of Female Beneficiaries | 3920 |
| Number Of Male Beneficiaries | 1635 |
| Number Of Non Hispanic White Beneficiaries | 4145 |
| Number Of Black or African American Beneficiaries | 731 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 614 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4431 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1124 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6619 |