| National Provider Identifier [NPI]: | 1043256910 |
| Last Name Of The Provider | DOMONT |
| First Name Of The Provider | LAWRENCE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1775 BALLARD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 600681005 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Endocrinology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 1332 |
| Number Of Medicare Beneficiaries | 491 |
| Total Submitted Charge Amount | 213035 |
| Total Medicare Allowed Amount | 117415.42 |
| Total Medicare Payment Amount | 86226.5 |
| Total Medicare Standardized Payment Amount | 79794.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 77 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1585 |
| Total Drug Medicare AllowedAmount | 1162.82 |
| Total Drug Medicare PaymentAmount | 971.56 |
| Total Drug Medicare Standardized Payment Amount | 971.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1255 |
| Number Of Medicare Beneficiaries With Medical Services | 491 |
| Total Medical Submitted Charge Amount | 211450 |
| Total Medical Medicare Allowed Amount | 116252.6 |
| Total Medical Medicare Payment Amount | 85254.94 |
| Total Medical Medicare Standardized Payment Amount | 78822.97 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 232 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 293 |
| Number Of Male Beneficiaries | 198 |
| Number Of Non Hispanic White Beneficiaries | 423 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 403 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 67 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4539 |