| National Provider Identifier [NPI]: | 1467407072 |
| Last Name Of The Provider | WILLIS |
| First Name Of The Provider | JERROLD |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 605 N 12TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT VERNON |
| Zip Code Of The Provider | 628642857 |
| 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 | 211 |
| Number Of Services | 4580 |
| Number Of Medicare Beneficiaries | 2439 |
| Total Submitted Charge Amount | 1033316.03 |
| Total Medicare Allowed Amount | 185154.56 |
| Total Medicare Payment Amount | 141513.62 |
| Total Medicare Standardized Payment Amount | 145620.25 |
| 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 | 211 |
| Number Of Medical Services | 4580 |
| Number Of Medicare Beneficiaries With Medical Services | 2439 |
| Total Medical Submitted Charge Amount | 1033316.03 |
| Total Medical Medicare Allowed Amount | 185154.56 |
| Total Medical Medicare Payment Amount | 141513.62 |
| Total Medical Medicare Standardized Payment Amount | 145620.25 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 506 |
| Number Of Beneficiaries Age 65 to 74 | 902 |
| Number Of Beneficiaries Age 75 to 84 | 646 |
| Number Of Beneficiaries Age Greater 84 | 385 |
| Number Of Female Beneficiaries | 1504 |
| Number Of Male Beneficiaries | 935 |
| Number Of Non Hispanic White Beneficiaries | 2323 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1579 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 860 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8444 |