| National Provider Identifier [NPI]: | 1972769222 |
| Last Name Of The Provider | KITTIKAMRON |
| First Name Of The Provider | KIRK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4646 N MARINE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606405759 |
| 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 | 21 |
| Number Of Services | 895 |
| Number Of Medicare Beneficiaries | 539 |
| Total Submitted Charge Amount | 483700 |
| Total Medicare Allowed Amount | 106309.84 |
| Total Medicare Payment Amount | 79341.15 |
| Total Medicare Standardized Payment Amount | 72922.35 |
| 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 | 21 |
| Number Of Medical Services | 895 |
| Number Of Medicare Beneficiaries With Medical Services | 539 |
| Total Medical Submitted Charge Amount | 483700 |
| Total Medical Medicare Allowed Amount | 106309.84 |
| Total Medical Medicare Payment Amount | 79341.15 |
| Total Medical Medicare Standardized Payment Amount | 72922.35 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | 142 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 316 |
| Number Of Male Beneficiaries | 223 |
| Number Of Non Hispanic White Beneficiaries | 342 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | 69 |
| Number Of Hispanic Beneficiaries | 79 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 230 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 309 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.1855 |