| National Provider Identifier [NPI]: | 1003862806 |
| Last Name Of The Provider | BOORSTEIN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2300 N EDWARD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DECATUR |
| Zip Code Of The Provider | 625264163 |
| 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 | 150 |
| Number Of Services | 11916 |
| Number Of Medicare Beneficiaries | 6227 |
| Total Submitted Charge Amount | 2126361 |
| Total Medicare Allowed Amount | 357423.96 |
| Total Medicare Payment Amount | 266309.37 |
| Total Medicare Standardized Payment Amount | 272493.33 |
| 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 | 150 |
| Number Of Medical Services | 11916 |
| Number Of Medicare Beneficiaries With Medical Services | 6227 |
| Total Medical Submitted Charge Amount | 2126361 |
| Total Medical Medicare Allowed Amount | 357423.96 |
| Total Medical Medicare Payment Amount | 266309.37 |
| Total Medical Medicare Standardized Payment Amount | 272493.33 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 940 |
| Number Of Beneficiaries Age 65 to 74 | 2323 |
| Number Of Beneficiaries Age 75 to 84 | 1901 |
| Number Of Beneficiaries Age Greater 84 | 1063 |
| Number Of Female Beneficiaries | 3680 |
| Number Of Male Beneficiaries | 2547 |
| Number Of Non Hispanic White Beneficiaries | 5550 |
| Number Of Black or African American Beneficiaries | 588 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4819 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1408 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4177 |