| National Provider Identifier [NPI]: | 1912010273 |
| Last Name Of The Provider | KULLBERG |
| First Name Of The Provider | FREDRIC |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5668 E STATE ST |
| Street Address 2 Of The Provider | SUITE B600 |
| City Of The Provider | ROCKFORD |
| Zip Code Of The Provider | 611082490 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 3511 |
| Number Of Medicare Beneficiaries | 1003 |
| Total Submitted Charge Amount | 511138 |
| Total Medicare Allowed Amount | 241577.49 |
| Total Medicare Payment Amount | 180807.73 |
| Total Medicare Standardized Payment Amount | 171072.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 685 |
| Total Drug Medicare AllowedAmount | 613.48 |
| Total Drug Medicare PaymentAmount | 601.2 |
| Total Drug Medicare Standardized Payment Amount | 601.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 3483 |
| Number Of Medicare Beneficiaries With Medical Services | 1003 |
| Total Medical Submitted Charge Amount | 510453 |
| Total Medical Medicare Allowed Amount | 240964.01 |
| Total Medical Medicare Payment Amount | 180206.53 |
| Total Medical Medicare Standardized Payment Amount | 170471.3 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 156 |
| Number Of Beneficiaries Age 65 to 74 | 378 |
| Number Of Beneficiaries Age 75 to 84 | 345 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 564 |
| Number Of Male Beneficiaries | 439 |
| Number Of Non Hispanic White Beneficiaries | 925 |
| Number Of Black or African American Beneficiaries | 43 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 798 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 205 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 26 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 52 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7919 |