| National Provider Identifier [NPI]: | 1467470815 |
| Last Name Of The Provider | FOOSANER |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 S MILWAUKEE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LIBERTYVILLE |
| Zip Code Of The Provider | 600483199 |
| 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 | 226 |
| Number Of Services | 5329 |
| Number Of Medicare Beneficiaries | 3110 |
| Total Submitted Charge Amount | 684924 |
| Total Medicare Allowed Amount | 182349.02 |
| Total Medicare Payment Amount | 139838.08 |
| Total Medicare Standardized Payment Amount | 133281.76 |
| 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 | 226 |
| Number Of Medical Services | 5329 |
| Number Of Medicare Beneficiaries With Medical Services | 3110 |
| Total Medical Submitted Charge Amount | 684924 |
| Total Medical Medicare Allowed Amount | 182349.02 |
| Total Medical Medicare Payment Amount | 139838.08 |
| Total Medical Medicare Standardized Payment Amount | 133281.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 412 |
| Number Of Beneficiaries Age 65 to 74 | 1157 |
| Number Of Beneficiaries Age 75 to 84 | 959 |
| Number Of Beneficiaries Age Greater 84 | 582 |
| Number Of Female Beneficiaries | 1969 |
| Number Of Male Beneficiaries | 1141 |
| Number Of Non Hispanic White Beneficiaries | 2597 |
| Number Of Black or African American Beneficiaries | 144 |
| Number Of AsianPacific Islander Beneficiaries | 89 |
| Number Of Hispanic Beneficiaries | 231 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2427 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 683 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7024 |