| National Provider Identifier [NPI]: | 1447416235 |
| Last Name Of The Provider | KENNEDY |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2160 S 1ST AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MAYWOOD |
| Zip Code Of The Provider | 601533328 |
| 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 | 234 |
| Number Of Services | 6174 |
| Number Of Medicare Beneficiaries | 2328 |
| Total Submitted Charge Amount | 733020.94 |
| Total Medicare Allowed Amount | 174994.86 |
| Total Medicare Payment Amount | 135612.37 |
| Total Medicare Standardized Payment Amount | 131355.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 2386 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 2386 |
| Total Drug Medicare AllowedAmount | 435.22 |
| Total Drug Medicare PaymentAmount | 328.34 |
| Total Drug Medicare Standardized Payment Amount | 328.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 233 |
| Number Of Medical Services | 3788 |
| Number Of Medicare Beneficiaries With Medical Services | 2328 |
| Total Medical Submitted Charge Amount | 730634.94 |
| Total Medical Medicare Allowed Amount | 174559.64 |
| Total Medical Medicare Payment Amount | 135284.03 |
| Total Medical Medicare Standardized Payment Amount | 131027.2 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 406 |
| Number Of Beneficiaries Age 65 to 74 | 865 |
| Number Of Beneficiaries Age 75 to 84 | 698 |
| Number Of Beneficiaries Age Greater 84 | 359 |
| Number Of Female Beneficiaries | 1406 |
| Number Of Male Beneficiaries | 922 |
| Number Of Non Hispanic White Beneficiaries | 1933 |
| Number Of Black or African American Beneficiaries | 153 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 203 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1691 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 637 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7158 |