| National Provider Identifier [NPI]: | 1588776017 |
| Last Name Of The Provider | KLEIN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 711 W NORTH AVE |
| Street Address 2 Of The Provider | 209 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606101174 |
| 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 | 34 |
| Number Of Services | 606 |
| Number Of Medicare Beneficiaries | 140 |
| Total Submitted Charge Amount | 65600 |
| Total Medicare Allowed Amount | 35253.51 |
| Total Medicare Payment Amount | 24303.53 |
| Total Medicare Standardized Payment Amount | 22950.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 95 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 4330 |
| Total Drug Medicare AllowedAmount | 1373.72 |
| Total Drug Medicare PaymentAmount | 1278.41 |
| Total Drug Medicare Standardized Payment Amount | 1278.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 511 |
| Number Of Medicare Beneficiaries With Medical Services | 140 |
| Total Medical Submitted Charge Amount | 61270 |
| Total Medical Medicare Allowed Amount | 33879.79 |
| Total Medical Medicare Payment Amount | 23025.12 |
| Total Medical Medicare Standardized Payment Amount | 21672.1 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 22 |
| Number Of Male Beneficiaries | 118 |
| Number Of Non Hispanic White Beneficiaries | 125 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 128 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 27 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7297 |