| National Provider Identifier [NPI]: | 1184885980 |
| Last Name Of The Provider | BONISH |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1653 W CONGRESS PKWY |
| Street Address 2 Of The Provider | 220 ANNEX BUILDING- DERMATOLOGY |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606123833 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 1341 |
| Number Of Medicare Beneficiaries | 594 |
| Total Submitted Charge Amount | 180996 |
| Total Medicare Allowed Amount | 82502.81 |
| Total Medicare Payment Amount | 61830.6 |
| Total Medicare Standardized Payment Amount | 57756.34 |
| 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 | 32 |
| Number Of Medical Services | 1341 |
| Number Of Medicare Beneficiaries With Medical Services | 594 |
| Total Medical Submitted Charge Amount | 180996 |
| Total Medical Medicare Allowed Amount | 82502.81 |
| Total Medical Medicare Payment Amount | 61830.6 |
| Total Medical Medicare Standardized Payment Amount | 57756.34 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 182 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 150 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 358 |
| Number Of Male Beneficiaries | 236 |
| Number Of Non Hispanic White Beneficiaries | 239 |
| Number Of Black or African American Beneficiaries | 234 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 107 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 347 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 247 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4906 |