| National Provider Identifier [NPI]: | 1851353395 |
| Last Name Of The Provider | GROSSMAN |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 934 CENTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELGIN |
| Zip Code Of The Provider | 601202125 |
| 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 | 207 |
| Number Of Services | 6752 |
| Number Of Medicare Beneficiaries | 3763 |
| Total Submitted Charge Amount | 785079 |
| Total Medicare Allowed Amount | 237034.17 |
| Total Medicare Payment Amount | 187703.8 |
| Total Medicare Standardized Payment Amount | 178884.95 |
| 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 | 207 |
| Number Of Medical Services | 6752 |
| Number Of Medicare Beneficiaries With Medical Services | 3763 |
| Total Medical Submitted Charge Amount | 785079 |
| Total Medical Medicare Allowed Amount | 237034.17 |
| Total Medical Medicare Payment Amount | 187703.8 |
| Total Medical Medicare Standardized Payment Amount | 178884.95 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 492 |
| Number Of Beneficiaries Age 65 to 74 | 1534 |
| Number Of Beneficiaries Age 75 to 84 | 1194 |
| Number Of Beneficiaries Age Greater 84 | 543 |
| Number Of Female Beneficiaries | 2416 |
| Number Of Male Beneficiaries | 1347 |
| Number Of Non Hispanic White Beneficiaries | 3187 |
| Number Of Black or African American Beneficiaries | 116 |
| Number Of AsianPacific Islander Beneficiaries | 107 |
| Number Of Hispanic Beneficiaries | 308 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3097 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 666 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.572 |