| National Provider Identifier [NPI]: | 1437262540 |
| Last Name Of The Provider | COLLETTE |
| First Name Of The Provider | DEAN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 E CARPENTER ST |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627025324 |
| 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 | 189 |
| Number Of Services | 5047 |
| Number Of Medicare Beneficiaries | 2991 |
| Total Submitted Charge Amount | 1060136 |
| Total Medicare Allowed Amount | 153977.96 |
| Total Medicare Payment Amount | 115845.59 |
| Total Medicare Standardized Payment Amount | 117062.41 |
| 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 | 189 |
| Number Of Medical Services | 5047 |
| Number Of Medicare Beneficiaries With Medical Services | 2991 |
| Total Medical Submitted Charge Amount | 1060136 |
| Total Medical Medicare Allowed Amount | 153977.96 |
| Total Medical Medicare Payment Amount | 115845.59 |
| Total Medical Medicare Standardized Payment Amount | 117062.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 506 |
| Number Of Beneficiaries Age 65 to 74 | 1025 |
| Number Of Beneficiaries Age 75 to 84 | 947 |
| Number Of Beneficiaries Age Greater 84 | 513 |
| Number Of Female Beneficiaries | 1491 |
| Number Of Male Beneficiaries | 1500 |
| Number Of Non Hispanic White Beneficiaries | 2796 |
| Number Of Black or African American Beneficiaries | 147 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2198 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 793 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.753 |