| National Provider Identifier [NPI]: | 1104866805 |
| Last Name Of The Provider | ECANOW |
| First Name Of The Provider | JACOB |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1416C SOUTH RANDALL ROAD |
| Street Address 2 Of The Provider | RANDALL SQUARE SHOPPING CENTER |
| City Of The Provider | GENEVA |
| Zip Code Of The Provider | 601344682 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 119 |
| Number Of Services | 7461 |
| Number Of Medicare Beneficiaries | 4730 |
| Total Submitted Charge Amount | 462933 |
| Total Medicare Allowed Amount | 147206.49 |
| Total Medicare Payment Amount | 119271.08 |
| Total Medicare Standardized Payment Amount | 111384.29 |
| 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 | 119 |
| Number Of Medical Services | 7461 |
| Number Of Medicare Beneficiaries With Medical Services | 4730 |
| Total Medical Submitted Charge Amount | 462933 |
| Total Medical Medicare Allowed Amount | 147206.49 |
| Total Medical Medicare Payment Amount | 119271.08 |
| Total Medical Medicare Standardized Payment Amount | 111384.29 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 332 |
| Number Of Beneficiaries Age 65 to 74 | 1901 |
| Number Of Beneficiaries Age 75 to 84 | 1519 |
| Number Of Beneficiaries Age Greater 84 | 978 |
| Number Of Female Beneficiaries | 3363 |
| Number Of Male Beneficiaries | 1367 |
| Number Of Non Hispanic White Beneficiaries | 4101 |
| Number Of Black or African American Beneficiaries | 230 |
| Number Of AsianPacific Islander Beneficiaries | 185 |
| Number Of Hispanic Beneficiaries | 123 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 91 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4063 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 667 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4328 |