| National Provider Identifier [NPI]: | 1437109816 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1800 HOLLISTER DRIVE |
| Street Address 2 Of The Provider | SUITE G-18 |
| City Of The Provider | LIBERTYVILLE |
| Zip Code Of The Provider | 600485264 |
| 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 | 143 |
| Number Of Services | 2801 |
| Number Of Medicare Beneficiaries | 1637 |
| Total Submitted Charge Amount | 385136 |
| Total Medicare Allowed Amount | 97269.73 |
| Total Medicare Payment Amount | 69275.6 |
| Total Medicare Standardized Payment Amount | 65824.9 |
| 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 | 143 |
| Number Of Medical Services | 2801 |
| Number Of Medicare Beneficiaries With Medical Services | 1637 |
| Total Medical Submitted Charge Amount | 385136 |
| Total Medical Medicare Allowed Amount | 97269.73 |
| Total Medical Medicare Payment Amount | 69275.6 |
| Total Medical Medicare Standardized Payment Amount | 65824.9 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 610 |
| Number Of Beneficiaries Age 65 to 74 | 590 |
| Number Of Beneficiaries Age 75 to 84 | 319 |
| Number Of Beneficiaries Age Greater 84 | 118 |
| Number Of Female Beneficiaries | 941 |
| Number Of Male Beneficiaries | 696 |
| Number Of Non Hispanic White Beneficiaries | 331 |
| Number Of Black or African American Beneficiaries | 853 |
| Number Of AsianPacific Islander Beneficiaries | 52 |
| Number Of Hispanic Beneficiaries | 381 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 577 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1060 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.365 |