| National Provider Identifier [NPI]: | 1295848109 |
| Last Name Of The Provider | DUDKIEWICZ |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1740 W TAYLOR ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606127232 |
| 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 | 26 |
| Number Of Services | 296 |
| Number Of Medicare Beneficiaries | 107 |
| Total Submitted Charge Amount | 57903 |
| Total Medicare Allowed Amount | 27006.19 |
| Total Medicare Payment Amount | 18424.66 |
| Total Medicare Standardized Payment Amount | 17271.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 927 |
| Total Drug Medicare AllowedAmount | 588.15 |
| Total Drug Medicare PaymentAmount | 569.8 |
| Total Drug Medicare Standardized Payment Amount | 569.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 273 |
| Number Of Medicare Beneficiaries With Medical Services | 107 |
| Total Medical Submitted Charge Amount | 56976 |
| Total Medical Medicare Allowed Amount | 26418.04 |
| Total Medical Medicare Payment Amount | 17854.86 |
| Total Medical Medicare Standardized Payment Amount | 16701.71 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 41 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 71 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 20 |
| Number Of Black or African American Beneficiaries | 68 |
| 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 | 44 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.847 |