| National Provider Identifier [NPI]: | 1295737195 |
| Last Name Of The Provider | DOLIN |
| First Name Of The Provider | EDWIN |
| 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 | PROVENA MERCY MEDICAL CENTER / RADIOLOGY DEPARTMENT |
| Street Address 2 Of The Provider | 1325 NORTH HIGHLAND AVENUE |
| City Of The Provider | AURORA |
| Zip Code Of The Provider | 60506 |
| 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 | 91 |
| Number Of Services | 3626 |
| Number Of Medicare Beneficiaries | 648 |
| Total Submitted Charge Amount | 195100 |
| Total Medicare Allowed Amount | 42612.12 |
| Total Medicare Payment Amount | 32020.44 |
| Total Medicare Standardized Payment Amount | 31268.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 2766 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 2766 |
| Total Drug Medicare AllowedAmount | 493.79 |
| Total Drug Medicare PaymentAmount | 317.74 |
| Total Drug Medicare Standardized Payment Amount | 317.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 860 |
| Number Of Medicare Beneficiaries With Medical Services | 648 |
| Total Medical Submitted Charge Amount | 192334 |
| Total Medical Medicare Allowed Amount | 42118.33 |
| Total Medical Medicare Payment Amount | 31702.7 |
| Total Medical Medicare Standardized Payment Amount | 30951.25 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 149 |
| Number Of Beneficiaries Age 65 to 74 | 239 |
| Number Of Beneficiaries Age 75 to 84 | 159 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 353 |
| Number Of Male Beneficiaries | 295 |
| Number Of Non Hispanic White Beneficiaries | 483 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 87 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 422 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 226 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8744 |