| National Provider Identifier [NPI]: | 1124004262 |
| Last Name Of The Provider | VERGARA |
| First Name Of The Provider | HUMBERTO |
| 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 | 1431 N WESTERN AVE |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606221797 |
| 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 | 23 |
| Number Of Services | 654 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 158152 |
| Total Medicare Allowed Amount | 67076.24 |
| Total Medicare Payment Amount | 48564.78 |
| Total Medicare Standardized Payment Amount | 46135.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 1597 |
| Total Drug Medicare AllowedAmount | 1187.5 |
| Total Drug Medicare PaymentAmount | 1163.49 |
| Total Drug Medicare Standardized Payment Amount | 1163.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 610 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 156555 |
| Total Medical Medicare Allowed Amount | 65888.74 |
| Total Medical Medicare Payment Amount | 47401.29 |
| Total Medical Medicare Standardized Payment Amount | 44972.22 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 46 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 55 |
| Number Of Male Beneficiaries | 99 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 85 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 51 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 103 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 30 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 57 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 23 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.481 |