| National Provider Identifier [NPI]: | 1326037383 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JONG-IL |
| 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 | 5454 HOHMAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAMMOND |
| Zip Code Of The Provider | 463201931 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 151 |
| Number Of Services | 4057 |
| Number Of Medicare Beneficiaries | 2527 |
| Total Submitted Charge Amount | 635463 |
| Total Medicare Allowed Amount | 113172.88 |
| Total Medicare Payment Amount | 83470.7 |
| Total Medicare Standardized Payment Amount | 87381.07 |
| 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 | 151 |
| Number Of Medical Services | 4057 |
| Number Of Medicare Beneficiaries With Medical Services | 2527 |
| Total Medical Submitted Charge Amount | 635463 |
| Total Medical Medicare Allowed Amount | 113172.88 |
| Total Medical Medicare Payment Amount | 83470.7 |
| Total Medical Medicare Standardized Payment Amount | 87381.07 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 509 |
| Number Of Beneficiaries Age 65 to 74 | 776 |
| Number Of Beneficiaries Age 75 to 84 | 758 |
| Number Of Beneficiaries Age Greater 84 | 484 |
| Number Of Female Beneficiaries | 1413 |
| Number Of Male Beneficiaries | 1114 |
| Number Of Non Hispanic White Beneficiaries | 1823 |
| Number Of Black or African American Beneficiaries | 528 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 148 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1741 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 786 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 52 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.292 |