| National Provider Identifier [NPI]: | 1649287947 |
| Last Name Of The Provider | SAMUEL |
| First Name Of The Provider | BENJAMIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2525 S MICHIGAN AVE |
| Street Address 2 Of The Provider | MAIL BOX 126 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606162333 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 1597 |
| Number Of Medicare Beneficiaries | 225 |
| Total Submitted Charge Amount | 251932 |
| Total Medicare Allowed Amount | 168095.94 |
| Total Medicare Payment Amount | 131324.34 |
| Total Medicare Standardized Payment Amount | 122833.12 |
| 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 | 13 |
| Number Of Medical Services | 1597 |
| Number Of Medicare Beneficiaries With Medical Services | 225 |
| Total Medical Submitted Charge Amount | 251932 |
| Total Medical Medicare Allowed Amount | 168095.94 |
| Total Medical Medicare Payment Amount | 131324.34 |
| Total Medical Medicare Standardized Payment Amount | 122833.12 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 68 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 98 |
| Number Of Non Hispanic White Beneficiaries | 25 |
| Number Of Black or African American Beneficiaries | 179 |
| 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 | 59 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 166 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 46 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 65 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 68 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | 28 |
| Average HCC Risk Score Of Beneficiaries | 4.0403 |