| National Provider Identifier [NPI]: | 1720155443 |
| Last Name Of The Provider | JESKE |
| First Name Of The Provider | JAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2650 RIDGE AVE |
| Street Address 2 Of The Provider | EVANSTON HOSPITAL |
| City Of The Provider | EVANSTON |
| Zip Code Of The Provider | 602011718 |
| 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 | 85 |
| Number Of Services | 6889 |
| Number Of Medicare Beneficiaries | 4205 |
| Total Submitted Charge Amount | 380935 |
| Total Medicare Allowed Amount | 127142.24 |
| Total Medicare Payment Amount | 107006.89 |
| Total Medicare Standardized Payment Amount | 98890.98 |
| 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 | 85 |
| Number Of Medical Services | 6889 |
| Number Of Medicare Beneficiaries With Medical Services | 4205 |
| Total Medical Submitted Charge Amount | 380935 |
| Total Medical Medicare Allowed Amount | 127142.24 |
| Total Medical Medicare Payment Amount | 107006.89 |
| Total Medical Medicare Standardized Payment Amount | 98890.98 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 252 |
| Number Of Beneficiaries Age 65 to 74 | 1665 |
| Number Of Beneficiaries Age 75 to 84 | 1356 |
| Number Of Beneficiaries Age Greater 84 | 932 |
| Number Of Female Beneficiaries | 3154 |
| Number Of Male Beneficiaries | 1051 |
| Number Of Non Hispanic White Beneficiaries | 3623 |
| Number Of Black or African American Beneficiaries | 266 |
| Number Of AsianPacific Islander Beneficiaries | 132 |
| Number Of Hispanic Beneficiaries | 103 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 81 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3678 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 527 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3535 |