| National Provider Identifier [NPI]: | 1881647048 |
| Last Name Of The Provider | HAEBICH |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3825 N CENTRAL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606342719 |
| 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 | 21 |
| Number Of Services | 4982 |
| Number Of Medicare Beneficiaries | 470 |
| Total Submitted Charge Amount | 650253 |
| Total Medicare Allowed Amount | 492563.23 |
| Total Medicare Payment Amount | 376746.5 |
| Total Medicare Standardized Payment Amount | 372482.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 118 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 8850 |
| Total Drug Medicare AllowedAmount | 3937.66 |
| Total Drug Medicare PaymentAmount | 3858.6 |
| Total Drug Medicare Standardized Payment Amount | 3858.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 4864 |
| Number Of Medicare Beneficiaries With Medical Services | 470 |
| Total Medical Submitted Charge Amount | 641403 |
| Total Medical Medicare Allowed Amount | 488625.57 |
| Total Medical Medicare Payment Amount | 372887.9 |
| Total Medical Medicare Standardized Payment Amount | 368624.36 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 291 |
| Number Of Male Beneficiaries | 179 |
| Number Of Non Hispanic White Beneficiaries | 405 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 191 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 279 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 49 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 28 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1789 |