| National Provider Identifier [NPI]: | 1093794745 |
| Last Name Of The Provider | RUDY |
| First Name Of The Provider | PAUL |
| 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 | 110 S DEPOT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ANNAWAN |
| Zip Code Of The Provider | 612347768 |
| 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 | 58 |
| Number Of Services | 1221 |
| Number Of Medicare Beneficiaries | 396 |
| Total Submitted Charge Amount | 123294.95 |
| Total Medicare Allowed Amount | 65949.77 |
| Total Medicare Payment Amount | 45331.88 |
| Total Medicare Standardized Payment Amount | 47973 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 4377 |
| Total Drug Medicare AllowedAmount | 2187.41 |
| Total Drug Medicare PaymentAmount | 2090.3 |
| Total Drug Medicare Standardized Payment Amount | 2090.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 1106 |
| Number Of Medicare Beneficiaries With Medical Services | 396 |
| Total Medical Submitted Charge Amount | 118917.95 |
| Total Medical Medicare Allowed Amount | 63762.36 |
| Total Medical Medicare Payment Amount | 43241.58 |
| Total Medical Medicare Standardized Payment Amount | 45882.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 59 |
| Number Of Female Beneficiaries | 194 |
| Number Of Male Beneficiaries | 202 |
| Number Of Non Hispanic White Beneficiaries | 382 |
| 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 | 363 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0363 |