National Provider Identifier [NPI]: |
1932148608 |
Last Name Of The Provider |
MAJOR |
First Name Of The Provider |
SHEILA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
355 RIDGE AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
EVANSTON |
Zip Code Of The Provider |
602023328 |
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 |
153 |
Number Of Services |
4312 |
Number Of Medicare Beneficiaries |
2254 |
Total Submitted Charge Amount |
604013 |
Total Medicare Allowed Amount |
142882.46 |
Total Medicare Payment Amount |
112689.69 |
Total Medicare Standardized Payment Amount |
106859.54 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
153 |
Number Of Medical Services |
4312 |
Number Of Medicare Beneficiaries With Medical Services |
2254 |
Total Medical Submitted Charge Amount |
604013 |
Total Medical Medicare Allowed Amount |
142882.46 |
Total Medical Medicare Payment Amount |
112689.69 |
Total Medical Medicare Standardized Payment Amount |
106859.54 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
427 |
Number Of Beneficiaries Age 65 to 74 |
734 |
Number Of Beneficiaries Age 75 to 84 |
644 |
Number Of Beneficiaries Age Greater 84 |
449 |
Number Of Female Beneficiaries |
1492 |
Number Of Male Beneficiaries |
762 |
Number Of Non Hispanic White Beneficiaries |
1437 |
Number Of Black or African American Beneficiaries |
402 |
Number Of AsianPacific Islander Beneficiaries |
166 |
Number Of Hispanic Beneficiaries |
194 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
1193 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
1061 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
37 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
52 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.8654 |