| National Provider Identifier [NPI]: | 1669456406 |
| Last Name Of The Provider | MAMON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4440 W 95TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAK LAWN |
| Zip Code Of The Provider | 604532600 |
| 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 | 229 |
| Number Of Services | 5095 |
| Number Of Medicare Beneficiaries | 2938 |
| Total Submitted Charge Amount | 1508369.62 |
| Total Medicare Allowed Amount | 181132.27 |
| Total Medicare Payment Amount | 144243.48 |
| Total Medicare Standardized Payment Amount | 133691.49 |
| 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 | 229 |
| Number Of Medical Services | 5095 |
| Number Of Medicare Beneficiaries With Medical Services | 2938 |
| Total Medical Submitted Charge Amount | 1508369.62 |
| Total Medical Medicare Allowed Amount | 181132.27 |
| Total Medical Medicare Payment Amount | 144243.48 |
| Total Medical Medicare Standardized Payment Amount | 133691.49 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 466 |
| Number Of Beneficiaries Age 65 to 74 | 1193 |
| Number Of Beneficiaries Age 75 to 84 | 915 |
| Number Of Beneficiaries Age Greater 84 | 364 |
| Number Of Female Beneficiaries | 2048 |
| Number Of Male Beneficiaries | 890 |
| Number Of Non Hispanic White Beneficiaries | 1862 |
| Number Of Black or African American Beneficiaries | 839 |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 169 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2170 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 768 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.0546 |