| National Provider Identifier [NPI]: | 1396705489 |
| Last Name Of The Provider | COULOMB |
| First Name Of The Provider | GLEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 S WASHINGTON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAPERVILLE |
| Zip Code Of The Provider | 605407430 |
| 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 | 16 |
| Number Of Services | 1871 |
| Number Of Medicare Beneficiaries | 342 |
| Total Submitted Charge Amount | 1036586 |
| Total Medicare Allowed Amount | 391453.93 |
| Total Medicare Payment Amount | 300379.02 |
| Total Medicare Standardized Payment Amount | 280194.06 |
| 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 | 1871 |
| Number Of Medicare Beneficiaries With Medical Services | 342 |
| Total Medical Submitted Charge Amount | 1036586 |
| Total Medical Medicare Allowed Amount | 391453.93 |
| Total Medical Medicare Payment Amount | 300379.02 |
| Total Medical Medicare Standardized Payment Amount | 280194.06 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 177 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 240 |
| Number Of Male Beneficiaries | 102 |
| Number Of Non Hispanic White Beneficiaries | 304 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 323 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0222 |