| National Provider Identifier [NPI]: | 1093773962 |
| Last Name Of The Provider | HIBBELN |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1725 W HARRISON ST |
| Street Address 2 Of The Provider | SUITE 456 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606123841 |
| 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 | 77 |
| Number Of Services | 47035 |
| Number Of Medicare Beneficiaries | 2797 |
| Total Submitted Charge Amount | 2257251 |
| Total Medicare Allowed Amount | 359143.28 |
| Total Medicare Payment Amount | 277857.87 |
| Total Medicare Standardized Payment Amount | 282955.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 42848 |
| Number Of Medicare Beneficiaries With Drug Services | 355 |
| Total Drug Submitted ChargeAmount | 176136 |
| Total Drug Medicare AllowedAmount | 10261.93 |
| Total Drug Medicare PaymentAmount | 8039.14 |
| Total Drug Medicare Standardized Payment Amount | 8039.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 4187 |
| Number Of Medicare Beneficiaries With Medical Services | 2795 |
| Total Medical Submitted Charge Amount | 2081115 |
| Total Medical Medicare Allowed Amount | 348881.35 |
| Total Medical Medicare Payment Amount | 269818.73 |
| Total Medical Medicare Standardized Payment Amount | 274916.45 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 746 |
| Number Of Beneficiaries Age 65 to 74 | 1075 |
| Number Of Beneficiaries Age 75 to 84 | 727 |
| Number Of Beneficiaries Age Greater 84 | 249 |
| Number Of Female Beneficiaries | 1567 |
| Number Of Male Beneficiaries | 1230 |
| Number Of Non Hispanic White Beneficiaries | 1191 |
| Number Of Black or African American Beneficiaries | 1102 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 408 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1657 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1140 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.4125 |