| National Provider Identifier [NPI]: | 1598921249 |
| Last Name Of The Provider | CAMPBELL |
| First Name Of The Provider | TRACY |
| 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 | 707 S WOOD ST |
| Street Address 2 Of The Provider | ANNEX 220 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606123840 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 5485 |
| Number Of Medicare Beneficiaries | 1082 |
| Total Submitted Charge Amount | 3638838 |
| Total Medicare Allowed Amount | 1381338.17 |
| Total Medicare Payment Amount | 1069389.46 |
| Total Medicare Standardized Payment Amount | 919057.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1460 |
| Total Drug Medicare AllowedAmount | 490.28 |
| Total Drug Medicare PaymentAmount | 382.92 |
| Total Drug Medicare Standardized Payment Amount | 382.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 5435 |
| Number Of Medicare Beneficiaries With Medical Services | 1082 |
| Total Medical Submitted Charge Amount | 3637378 |
| Total Medical Medicare Allowed Amount | 1380847.89 |
| Total Medical Medicare Payment Amount | 1069006.54 |
| Total Medical Medicare Standardized Payment Amount | 918674.86 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 458 |
| Number Of Beneficiaries Age 75 to 84 | 410 |
| Number Of Beneficiaries Age Greater 84 | 193 |
| Number Of Female Beneficiaries | 572 |
| Number Of Male Beneficiaries | 510 |
| Number Of Non Hispanic White Beneficiaries | 1049 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1045 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0023 |