National Provider Identifier [NPI]: |
1932355070 |
Last Name Of The Provider |
CHAN |
First Name Of The Provider |
CINDY |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4440 W 95TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
OAK LAWN |
Zip Code Of The Provider |
604532600 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
177 |
Number Of Medicare Beneficiaries |
167 |
Total Submitted Charge Amount |
77171 |
Total Medicare Allowed Amount |
29653.3 |
Total Medicare Payment Amount |
21373.65 |
Total Medicare Standardized Payment Amount |
19605.13 |
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 |
11 |
Number Of Medical Services |
177 |
Number Of Medicare Beneficiaries With Medical Services |
167 |
Total Medical Submitted Charge Amount |
77171 |
Total Medical Medicare Allowed Amount |
29653.3 |
Total Medical Medicare Payment Amount |
21373.65 |
Total Medical Medicare Standardized Payment Amount |
19605.13 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
48 |
Number Of Beneficiaries Age 75 to 84 |
44 |
Number Of Beneficiaries Age Greater 84 |
42 |
Number Of Female Beneficiaries |
104 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
101 |
Number Of Black or African American Beneficiaries |
44 |
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 |
109 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
58 |
Percent Of With Atrial Fibrillation |
22 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
49 |
Percent Of With Chronic Kidney Disease |
56 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
56 |
Percent Of With Hyperlipidemia |
72 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
59 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
53 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
2.2731 |