| National Provider Identifier [NPI]: | 1831135615 |
| Last Name Of The Provider | THACHENKERY |
| First Name Of The Provider | MARIA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2619 E 75TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606493705 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 3217 |
| Number Of Medicare Beneficiaries | 714 |
| Total Submitted Charge Amount | 486126.39 |
| Total Medicare Allowed Amount | 334180.04 |
| Total Medicare Payment Amount | 264402.99 |
| Total Medicare Standardized Payment Amount | 248351.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 607.2 |
| Total Drug Medicare AllowedAmount | 395.7 |
| Total Drug Medicare PaymentAmount | 387.82 |
| Total Drug Medicare Standardized Payment Amount | 387.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 3188 |
| Number Of Medicare Beneficiaries With Medical Services | 714 |
| Total Medical Submitted Charge Amount | 485519.19 |
| Total Medical Medicare Allowed Amount | 333784.34 |
| Total Medical Medicare Payment Amount | 264015.17 |
| Total Medical Medicare Standardized Payment Amount | 247964.13 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 197 |
| Number Of Beneficiaries Age 65 to 74 | 219 |
| Number Of Beneficiaries Age 75 to 84 | 187 |
| Number Of Beneficiaries Age Greater 84 | 111 |
| Number Of Female Beneficiaries | 428 |
| Number Of Male Beneficiaries | 286 |
| Number Of Non Hispanic White Beneficiaries | 76 |
| Number Of Black or African American Beneficiaries | 585 |
| 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 | 280 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 434 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 27 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 52 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.8898 |