| National Provider Identifier [NPI]: | 1508885567 |
| Last Name Of The Provider | FULD |
| First Name Of The Provider | IRVING |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2800 W 95TH STREET |
| Street Address 2 Of The Provider | LITTLE COMPANY OF MARY HOSPITAL |
| City Of The Provider | EVERGREEN |
| Zip Code Of The Provider | 60805 |
| 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 | 142 |
| Number Of Services | 6718 |
| Number Of Medicare Beneficiaries | 3662 |
| Total Submitted Charge Amount | 1339850 |
| Total Medicare Allowed Amount | 188672.74 |
| Total Medicare Payment Amount | 139836.13 |
| Total Medicare Standardized Payment Amount | 132188.73 |
| 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 | 142 |
| Number Of Medical Services | 6718 |
| Number Of Medicare Beneficiaries With Medical Services | 3662 |
| Total Medical Submitted Charge Amount | 1339850 |
| Total Medical Medicare Allowed Amount | 188672.74 |
| Total Medical Medicare Payment Amount | 139836.13 |
| Total Medical Medicare Standardized Payment Amount | 132188.73 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 484 |
| Number Of Beneficiaries Age 65 to 74 | 1161 |
| Number Of Beneficiaries Age 75 to 84 | 1230 |
| Number Of Beneficiaries Age Greater 84 | 787 |
| Number Of Female Beneficiaries | 2262 |
| Number Of Male Beneficiaries | 1400 |
| Number Of Non Hispanic White Beneficiaries | 1740 |
| Number Of Black or African American Beneficiaries | 1758 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 131 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2682 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 980 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9984 |