| National Provider Identifier [NPI]: | 1225272172 |
| Last Name Of The Provider | SCHIEBOUT |
| First Name Of The Provider | JESSEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1423 CHICAGO RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO HEIGHTS |
| Zip Code Of The Provider | 604113400 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 1020 |
| Number Of Medicare Beneficiaries | 679 |
| Total Submitted Charge Amount | 444478 |
| Total Medicare Allowed Amount | 127538.91 |
| Total Medicare Payment Amount | 96915.01 |
| Total Medicare Standardized Payment Amount | 90169.98 |
| 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 | 42 |
| Number Of Medical Services | 1020 |
| Number Of Medicare Beneficiaries With Medical Services | 679 |
| Total Medical Submitted Charge Amount | 444478 |
| Total Medical Medicare Allowed Amount | 127538.91 |
| Total Medical Medicare Payment Amount | 96915.01 |
| Total Medical Medicare Standardized Payment Amount | 90169.98 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 198 |
| Number Of Beneficiaries Age 65 to 74 | 194 |
| Number Of Beneficiaries Age 75 to 84 | 177 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 397 |
| Number Of Male Beneficiaries | 282 |
| Number Of Non Hispanic White Beneficiaries | 257 |
| Number Of Black or African American Beneficiaries | 320 |
| 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 | 344 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 335 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.5851 |