| National Provider Identifier [NPI]: | 1194755843 |
| Last Name Of The Provider | HEREDIA |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2900 FOXFIELD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST CHARLES |
| Zip Code Of The Provider | 601745799 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 545 |
| Number Of Medicare Beneficiaries | 132 |
| Total Submitted Charge Amount | 69864.35 |
| Total Medicare Allowed Amount | 37651.21 |
| Total Medicare Payment Amount | 30887.64 |
| Total Medicare Standardized Payment Amount | 29683.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 86 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 13008.35 |
| Total Drug Medicare AllowedAmount | 7050.33 |
| Total Drug Medicare PaymentAmount | 6895.21 |
| Total Drug Medicare Standardized Payment Amount | 6895.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 459 |
| Number Of Medicare Beneficiaries With Medical Services | 132 |
| Total Medical Submitted Charge Amount | 56856 |
| Total Medical Medicare Allowed Amount | 30600.88 |
| Total Medical Medicare Payment Amount | 23992.43 |
| Total Medical Medicare Standardized Payment Amount | 22788.08 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 24 |
| Number Of Non Hispanic White Beneficiaries | 121 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 11 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 39 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.662 |