| National Provider Identifier [NPI]: | 1124021795 |
| Last Name Of The Provider | CHARLESTON |
| First Name Of The Provider | GOMEZ |
| 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 | 9000 S STONY ISLAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606173508 |
| 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 | 30 |
| Number Of Services | 3910 |
| Number Of Medicare Beneficiaries | 511 |
| Total Submitted Charge Amount | 565821 |
| Total Medicare Allowed Amount | 237844.07 |
| Total Medicare Payment Amount | 162203.01 |
| Total Medicare Standardized Payment Amount | 155028.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 339 |
| Number Of Medicare Beneficiaries With Drug Services | 248 |
| Total Drug Submitted ChargeAmount | 11216 |
| Total Drug Medicare AllowedAmount | 6413.54 |
| Total Drug Medicare PaymentAmount | 6228.08 |
| Total Drug Medicare Standardized Payment Amount | 6228.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 3571 |
| Number Of Medicare Beneficiaries With Medical Services | 509 |
| Total Medical Submitted Charge Amount | 554605 |
| Total Medical Medicare Allowed Amount | 231430.53 |
| Total Medical Medicare Payment Amount | 155974.93 |
| Total Medical Medicare Standardized Payment Amount | 148800.44 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 178 |
| Number Of Beneficiaries Age Greater 84 | 77 |
| Number Of Female Beneficiaries | 315 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 498 |
| 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 | 471 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 6 |
| Percent Of With Diabetes | 73 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1348 |