| National Provider Identifier [NPI]: | 1922037308 |
| Last Name Of The Provider | ROCHE |
| First Name Of The Provider | FLORENCE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | RESURRECTION IMMEDIATE CARE CENTER |
| Street Address 2 Of The Provider | 7230 W. NORTH AVE, STE 106 B |
| City Of The Provider | ELMWOOD PARK |
| Zip Code Of The Provider | 607074262 |
| 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 | 25 |
| Number Of Services | 324 |
| Number Of Medicare Beneficiaries | 198 |
| Total Submitted Charge Amount | 42998 |
| Total Medicare Allowed Amount | 17359.45 |
| Total Medicare Payment Amount | 11689.99 |
| Total Medicare Standardized Payment Amount | 10940.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 1134 |
| Total Drug Medicare AllowedAmount | 19.28 |
| Total Drug Medicare PaymentAmount | 12.72 |
| Total Drug Medicare Standardized Payment Amount | 12.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 262 |
| Number Of Medicare Beneficiaries With Medical Services | 198 |
| Total Medical Submitted Charge Amount | 41864 |
| Total Medical Medicare Allowed Amount | 17340.17 |
| Total Medical Medicare Payment Amount | 11677.27 |
| Total Medical Medicare Standardized Payment Amount | 10927.81 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 65 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 130 |
| Number Of Male Beneficiaries | 68 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 179 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9303 |