National Provider Identifier [NPI]: |
1902839111 |
Last Name Of The Provider |
ALHAFEZ |
First Name Of The Provider |
FADI |
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 |
2003 W FULTON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606122345 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
593 |
Number Of Medicare Beneficiaries |
326 |
Total Submitted Charge Amount |
160514 |
Total Medicare Allowed Amount |
65622.63 |
Total Medicare Payment Amount |
50889.11 |
Total Medicare Standardized Payment Amount |
52156.29 |
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 |
16 |
Number Of Medical Services |
593 |
Number Of Medicare Beneficiaries With Medical Services |
326 |
Total Medical Submitted Charge Amount |
160514 |
Total Medical Medicare Allowed Amount |
65622.63 |
Total Medical Medicare Payment Amount |
50889.11 |
Total Medical Medicare Standardized Payment Amount |
52156.29 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
62 |
Number Of Beneficiaries Age 65 to 74 |
113 |
Number Of Beneficiaries Age 75 to 84 |
84 |
Number Of Beneficiaries Age Greater 84 |
67 |
Number Of Female Beneficiaries |
166 |
Number Of Male Beneficiaries |
160 |
Number Of Non Hispanic White Beneficiaries |
265 |
Number Of Black or African American Beneficiaries |
20 |
Number Of AsianPacific Islander Beneficiaries |
11 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
15 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
197 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
129 |
Percent Of With Atrial Fibrillation |
28 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
51 |
Percent Of With Chronic Kidney Disease |
57 |
Percent Of With Chronic Obstructive Pulmonary Disease |
38 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
50 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
59 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
17 |
Average HCC Risk Score Of Beneficiaries |
2.4844 |