| National Provider Identifier [NPI]: | 1629059662 |
| Last Name Of The Provider | MENCHACA |
| First Name Of The Provider | MARTHA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4130 W 26TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606234312 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 4461 |
| Number Of Medicare Beneficiaries | 2078 |
| Total Submitted Charge Amount | 254322 |
| Total Medicare Allowed Amount | 67379.63 |
| Total Medicare Payment Amount | 50448.84 |
| Total Medicare Standardized Payment Amount | 47299.86 |
| 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 | 114 |
| Number Of Medical Services | 4461 |
| Number Of Medicare Beneficiaries With Medical Services | 2078 |
| Total Medical Submitted Charge Amount | 254322 |
| Total Medical Medicare Allowed Amount | 67379.63 |
| Total Medical Medicare Payment Amount | 50448.84 |
| Total Medical Medicare Standardized Payment Amount | 47299.86 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 861 |
| Number Of Beneficiaries Age 65 to 74 | 689 |
| Number Of Beneficiaries Age 75 to 84 | 397 |
| Number Of Beneficiaries Age Greater 84 | 131 |
| Number Of Female Beneficiaries | 1165 |
| Number Of Male Beneficiaries | 913 |
| Number Of Non Hispanic White Beneficiaries | 427 |
| Number Of Black or African American Beneficiaries | 1122 |
| Number Of AsianPacific Islander Beneficiaries | 44 |
| Number Of Hispanic Beneficiaries | 461 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 719 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1359 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.5614 |