| National Provider Identifier [NPI]: | 1750302253 |
| Last Name Of The Provider | CHINN |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1404 WASHINGTON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MENDOTA |
| Zip Code Of The Provider | 613421471 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 1627 |
| Number Of Medicare Beneficiaries | 385 |
| Total Submitted Charge Amount | 229727 |
| Total Medicare Allowed Amount | 129749.03 |
| Total Medicare Payment Amount | 95043.78 |
| Total Medicare Standardized Payment Amount | 98841.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 1384 |
| Total Drug Medicare AllowedAmount | 777.33 |
| Total Drug Medicare PaymentAmount | 752.25 |
| Total Drug Medicare Standardized Payment Amount | 752.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 1565 |
| Number Of Medicare Beneficiaries With Medical Services | 385 |
| Total Medical Submitted Charge Amount | 228343 |
| Total Medical Medicare Allowed Amount | 128971.7 |
| Total Medical Medicare Payment Amount | 94291.53 |
| Total Medical Medicare Standardized Payment Amount | 98089.17 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 105 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 258 |
| Number Of Male Beneficiaries | 127 |
| Number Of Non Hispanic White Beneficiaries | 370 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 346 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0723 |