| National Provider Identifier [NPI]: | 1548224306 |
| Last Name Of The Provider | MITTAL |
| First Name Of The Provider | RAJ |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6419 W 87TH ST |
| Street Address 2 Of The Provider | SUITE 1 |
| City Of The Provider | OAK LAWN |
| Zip Code Of The Provider | 604531072 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 34805 |
| Number Of Medicare Beneficiaries | 390 |
| Total Submitted Charge Amount | 1403943 |
| Total Medicare Allowed Amount | 717125.65 |
| Total Medicare Payment Amount | 553448.75 |
| Total Medicare Standardized Payment Amount | 542104.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 36 |
| Number Of Drug Services | 32406 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 1019659 |
| Total Drug Medicare AllowedAmount | 509325.82 |
| Total Drug Medicare PaymentAmount | 398551.93 |
| Total Drug Medicare Standardized Payment Amount | 398551.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 2399 |
| Number Of Medicare Beneficiaries With Medical Services | 390 |
| Total Medical Submitted Charge Amount | 384284 |
| Total Medical Medicare Allowed Amount | 207799.83 |
| Total Medical Medicare Payment Amount | 154896.82 |
| Total Medical Medicare Standardized Payment Amount | 143552.92 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 140 |
| Number Of Beneficiaries Age 75 to 84 | 123 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 235 |
| Number Of Male Beneficiaries | 155 |
| Number Of Non Hispanic White Beneficiaries | 125 |
| Number Of Black or African American Beneficiaries | 232 |
| 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 | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 213 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 41 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 3.0664 |