| National Provider Identifier [NPI]: | 1750383527 |
| Last Name Of The Provider | DORGAN |
| First Name Of The Provider | KATHLEEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 ERIE CT |
| Street Address 2 Of The Provider | SUITE4120 |
| City Of The Provider | OAK PARK |
| Zip Code Of The Provider | 603022566 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 13813 |
| Number Of Medicare Beneficiaries | 108 |
| Total Submitted Charge Amount | 103695 |
| Total Medicare Allowed Amount | 49975.48 |
| Total Medicare Payment Amount | 38126.9 |
| Total Medicare Standardized Payment Amount | 39644.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 13195 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 48958 |
| Total Drug Medicare AllowedAmount | 27471 |
| Total Drug Medicare PaymentAmount | 20881.94 |
| Total Drug Medicare Standardized Payment Amount | 20881.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 7 |
| Number Of Medical Services | 618 |
| Number Of Medicare Beneficiaries With Medical Services | 108 |
| Total Medical Submitted Charge Amount | 54737 |
| Total Medical Medicare Allowed Amount | 22504.48 |
| Total Medical Medicare Payment Amount | 17244.96 |
| Total Medical Medicare Standardized Payment Amount | 18762.9 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 54 |
| Number Of Non Hispanic White Beneficiaries | 19 |
| Number Of Black or African American Beneficiaries | 78 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 43 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 65 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 71 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 68 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 7.126 |