| National Provider Identifier [NPI]: | 1346240421 |
| Last Name Of The Provider | LAURENT |
| First Name Of The Provider | ELISA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1420 RENAISSANCE DR |
| Street Address 2 Of The Provider | SUITE #307 |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 600681330 |
| 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 | 117 |
| Number Of Services | 4795 |
| Number Of Medicare Beneficiaries | 3185 |
| Total Submitted Charge Amount | 626498 |
| Total Medicare Allowed Amount | 128996.55 |
| Total Medicare Payment Amount | 101837.97 |
| Total Medicare Standardized Payment Amount | 95913.22 |
| 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 | 117 |
| Number Of Medical Services | 4795 |
| Number Of Medicare Beneficiaries With Medical Services | 3185 |
| Total Medical Submitted Charge Amount | 626498 |
| Total Medical Medicare Allowed Amount | 128996.55 |
| Total Medical Medicare Payment Amount | 101837.97 |
| Total Medical Medicare Standardized Payment Amount | 95913.22 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 249 |
| Number Of Beneficiaries Age 65 to 74 | 1180 |
| Number Of Beneficiaries Age 75 to 84 | 1103 |
| Number Of Beneficiaries Age Greater 84 | 653 |
| Number Of Female Beneficiaries | 2169 |
| Number Of Male Beneficiaries | 1016 |
| Number Of Non Hispanic White Beneficiaries | 2790 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 178 |
| Number Of Hispanic Beneficiaries | 135 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2598 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 587 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5473 |