| National Provider Identifier [NPI]: | 1003994112 |
| Last Name Of The Provider | SPACCAPANICCIA |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2340 S HIGHLAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOMBARD |
| Zip Code Of The Provider | 601485371 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 3651 |
| Number Of Medicare Beneficiaries | 748 |
| Total Submitted Charge Amount | 471761 |
| Total Medicare Allowed Amount | 298797.28 |
| Total Medicare Payment Amount | 218429.01 |
| Total Medicare Standardized Payment Amount | 204822.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 39 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 780 |
| Total Drug Medicare AllowedAmount | 69.43 |
| Total Drug Medicare PaymentAmount | 51.49 |
| Total Drug Medicare Standardized Payment Amount | 51.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 3612 |
| Number Of Medicare Beneficiaries With Medical Services | 748 |
| Total Medical Submitted Charge Amount | 470981 |
| Total Medical Medicare Allowed Amount | 298727.85 |
| Total Medical Medicare Payment Amount | 218377.52 |
| Total Medical Medicare Standardized Payment Amount | 204770.96 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 226 |
| Number Of Beneficiaries Age 75 to 84 | 269 |
| Number Of Beneficiaries Age Greater 84 | 219 |
| Number Of Female Beneficiaries | 433 |
| Number Of Male Beneficiaries | 315 |
| Number Of Non Hispanic White Beneficiaries | 651 |
| Number Of Black or African American Beneficiaries | 46 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 697 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6227 |