| National Provider Identifier [NPI]: | 1700906997 |
| Last Name Of The Provider | ELIAS |
| First Name Of The Provider | AUGUSTO |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3050 MONTVALE DR STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627046924 |
| 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 | 85 |
| Number Of Services | 2183 |
| Number Of Medicare Beneficiaries | 1302 |
| Total Submitted Charge Amount | 736144 |
| Total Medicare Allowed Amount | 133343.57 |
| Total Medicare Payment Amount | 103693.74 |
| Total Medicare Standardized Payment Amount | 109353.83 |
| 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 | 85 |
| Number Of Medical Services | 2183 |
| Number Of Medicare Beneficiaries With Medical Services | 1302 |
| Total Medical Submitted Charge Amount | 736144 |
| Total Medical Medicare Allowed Amount | 133343.57 |
| Total Medical Medicare Payment Amount | 103693.74 |
| Total Medical Medicare Standardized Payment Amount | 109353.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 319 |
| Number Of Beneficiaries Age 65 to 74 | 403 |
| Number Of Beneficiaries Age 75 to 84 | 352 |
| Number Of Beneficiaries Age Greater 84 | 228 |
| Number Of Female Beneficiaries | 723 |
| Number Of Male Beneficiaries | 579 |
| Number Of Non Hispanic White Beneficiaries | 1173 |
| Number Of Black or African American Beneficiaries | 94 |
| 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 | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 914 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 388 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 1.7455 |