| National Provider Identifier [NPI]: | 1104824135 |
| Last Name Of The Provider | RUDA |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | RN,MS,APN,ONC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7600 W COLLEGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALOS HEIGHTS |
| Zip Code Of The Provider | 604631001 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 659 |
| Number Of Medicare Beneficiaries | 243 |
| Total Submitted Charge Amount | 164864.01 |
| Total Medicare Allowed Amount | 38844.42 |
| Total Medicare Payment Amount | 28869.17 |
| Total Medicare Standardized Payment Amount | 30708.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 149 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 35210 |
| Total Drug Medicare AllowedAmount | 14057.8 |
| Total Drug Medicare PaymentAmount | 10771.61 |
| Total Drug Medicare Standardized Payment Amount | 10771.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 510 |
| Number Of Medicare Beneficiaries With Medical Services | 243 |
| Total Medical Submitted Charge Amount | 129654.01 |
| Total Medical Medicare Allowed Amount | 24786.62 |
| Total Medical Medicare Payment Amount | 18097.56 |
| Total Medical Medicare Standardized Payment Amount | 19936.46 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 110 |
| Number Of Beneficiaries Age 75 to 84 | 77 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 65 |
| Number Of Non Hispanic White Beneficiaries | 222 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 216 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1239 |