| National Provider Identifier [NPI]: | 1235316589 |
| Last Name Of The Provider | PAN |
| First Name Of The Provider | JAMES |
| 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 | 340 W MILLER ST |
| Street Address 2 Of The Provider | 1ST FLOOR |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627024928 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 115 |
| Number Of Services | 913 |
| Number Of Medicare Beneficiaries | 386 |
| Total Submitted Charge Amount | 1381148 |
| Total Medicare Allowed Amount | 139946.36 |
| Total Medicare Payment Amount | 109556.53 |
| Total Medicare Standardized Payment Amount | 107789.23 |
| 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 | 115 |
| Number Of Medical Services | 913 |
| Number Of Medicare Beneficiaries With Medical Services | 386 |
| Total Medical Submitted Charge Amount | 1381148 |
| Total Medical Medicare Allowed Amount | 139946.36 |
| Total Medical Medicare Payment Amount | 109556.53 |
| Total Medical Medicare Standardized Payment Amount | 107789.23 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 136 |
| Number Of Beneficiaries Age 75 to 84 | 105 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 184 |
| Number Of Male Beneficiaries | 202 |
| Number Of Non Hispanic White Beneficiaries | 343 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 264 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.4968 |