| National Provider Identifier [NPI]: | 1407817117 |
| Last Name Of The Provider | KAPUSTIAK |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11600 S KEDZIE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MERRIONETTE PARK |
| Zip Code Of The Provider | 60803 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 5780 |
| Number Of Medicare Beneficiaries | 1385 |
| Total Submitted Charge Amount | 640530.42 |
| Total Medicare Allowed Amount | 350899.54 |
| Total Medicare Payment Amount | 246075.94 |
| Total Medicare Standardized Payment Amount | 221184.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3320 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 33200 |
| Total Drug Medicare AllowedAmount | 18302.64 |
| Total Drug Medicare PaymentAmount | 14349.24 |
| Total Drug Medicare Standardized Payment Amount | 14349.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2460 |
| Number Of Medicare Beneficiaries With Medical Services | 1385 |
| Total Medical Submitted Charge Amount | 607330.42 |
| Total Medical Medicare Allowed Amount | 332596.9 |
| Total Medical Medicare Payment Amount | 231726.7 |
| Total Medical Medicare Standardized Payment Amount | 206835.42 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 597 |
| Number Of Beneficiaries Age 75 to 84 | 491 |
| Number Of Beneficiaries Age Greater 84 | 201 |
| Number Of Female Beneficiaries | 862 |
| Number Of Male Beneficiaries | 523 |
| Number Of Non Hispanic White Beneficiaries | 890 |
| Number Of Black or African American Beneficiaries | 419 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1268 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1298 |