| National Provider Identifier [NPI]: | 1346290707 |
| Last Name Of The Provider | SIH |
| First Name Of The Provider | RAHMAWATI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5101 WILLOW SPRINGS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA GRANGE |
| Zip Code Of The Provider | 605252600 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 3659 |
| Number Of Medicare Beneficiaries | 691 |
| Total Submitted Charge Amount | 750825 |
| Total Medicare Allowed Amount | 364679.2 |
| Total Medicare Payment Amount | 271741.45 |
| Total Medicare Standardized Payment Amount | 254988.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 129 |
| Number Of Medicare Beneficiaries With Drug Services | 120 |
| Total Drug Submitted ChargeAmount | 4150 |
| Total Drug Medicare AllowedAmount | 1482.59 |
| Total Drug Medicare PaymentAmount | 1442 |
| Total Drug Medicare Standardized Payment Amount | 1442 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 3530 |
| Number Of Medicare Beneficiaries With Medical Services | 691 |
| Total Medical Submitted Charge Amount | 746675 |
| Total Medical Medicare Allowed Amount | 363196.61 |
| Total Medical Medicare Payment Amount | 270299.45 |
| Total Medical Medicare Standardized Payment Amount | 253546.43 |
| Average Age Of Beneficiaries | 86 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 180 |
| Number Of Beneficiaries Age Greater 84 | 445 |
| Number Of Female Beneficiaries | 526 |
| Number Of Male Beneficiaries | 165 |
| Number Of Non Hispanic White Beneficiaries | 661 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 651 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 55 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 29 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8024 |