| National Provider Identifier [NPI]: | 1760583629 |
| Last Name Of The Provider | GUPTA |
| First Name Of The Provider | VANITA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 901 CENTER ST |
| Street Address 2 Of The Provider | SUITE 3000 |
| City Of The Provider | ELGIN |
| Zip Code Of The Provider | 601202104 |
| 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 | 42 |
| Number Of Services | 919 |
| Number Of Medicare Beneficiaries | 198 |
| Total Submitted Charge Amount | 95170.04 |
| Total Medicare Allowed Amount | 53874.69 |
| Total Medicare Payment Amount | 41238.24 |
| Total Medicare Standardized Payment Amount | 39154.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 271 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 9695 |
| Total Drug Medicare AllowedAmount | 5008.73 |
| Total Drug Medicare PaymentAmount | 4230.96 |
| Total Drug Medicare Standardized Payment Amount | 4230.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 648 |
| Number Of Medicare Beneficiaries With Medical Services | 198 |
| Total Medical Submitted Charge Amount | 85475.04 |
| Total Medical Medicare Allowed Amount | 48865.96 |
| Total Medical Medicare Payment Amount | 37007.28 |
| Total Medical Medicare Standardized Payment Amount | 34923.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 151 |
| Number Of Male Beneficiaries | 47 |
| Number Of Non Hispanic White Beneficiaries | 152 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 146 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.2809 |