| National Provider Identifier [NPI]: | 1912950916 |
| Last Name Of The Provider | DIPASQUO |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12701 W 143RD ST |
| Street Address 2 Of The Provider | SUITE 250 |
| City Of The Provider | HOMER GLEN |
| Zip Code Of The Provider | 604917715 |
| 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 | 51 |
| Number Of Services | 3003 |
| Number Of Medicare Beneficiaries | 507 |
| Total Submitted Charge Amount | 217215.72 |
| Total Medicare Allowed Amount | 212586.74 |
| Total Medicare Payment Amount | 149222.63 |
| Total Medicare Standardized Payment Amount | 141736.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 120 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 1642.38 |
| Total Drug Medicare AllowedAmount | 1636.14 |
| Total Drug Medicare PaymentAmount | 1580.84 |
| Total Drug Medicare Standardized Payment Amount | 1580.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 2883 |
| Number Of Medicare Beneficiaries With Medical Services | 507 |
| Total Medical Submitted Charge Amount | 215573.34 |
| Total Medical Medicare Allowed Amount | 210950.6 |
| Total Medical Medicare Payment Amount | 147641.79 |
| Total Medical Medicare Standardized Payment Amount | 140155.82 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 273 |
| Number Of Beneficiaries Age 75 to 84 | 146 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 260 |
| Number Of Male Beneficiaries | 247 |
| Number Of Non Hispanic White Beneficiaries | 487 |
| 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 | 495 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.0899 |