| National Provider Identifier [NPI]: | 1932114741 |
| Last Name Of The Provider | SHEVLIN |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 701 N 1ST ST |
| Street Address 2 Of The Provider | MEMORIAL MEDICAL CENTER DEPARTMENT OF LABORATORY MEDICI |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 62781 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 3360 |
| Number Of Medicare Beneficiaries | 1304 |
| Total Submitted Charge Amount | 475803.88 |
| Total Medicare Allowed Amount | 133717.38 |
| Total Medicare Payment Amount | 103551.94 |
| Total Medicare Standardized Payment Amount | 82577.86 |
| 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 | 31 |
| Number Of Medical Services | 3360 |
| Number Of Medicare Beneficiaries With Medical Services | 1304 |
| Total Medical Submitted Charge Amount | 475803.88 |
| Total Medical Medicare Allowed Amount | 133717.38 |
| Total Medical Medicare Payment Amount | 103551.94 |
| Total Medical Medicare Standardized Payment Amount | 82577.86 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 177 |
| Number Of Beneficiaries Age 65 to 74 | 585 |
| Number Of Beneficiaries Age 75 to 84 | 387 |
| Number Of Beneficiaries Age Greater 84 | 155 |
| Number Of Female Beneficiaries | 706 |
| Number Of Male Beneficiaries | 598 |
| Number Of Non Hispanic White Beneficiaries | 1221 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1135 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 169 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4219 |