| National Provider Identifier [NPI]: | 1639161110 |
| Last Name Of The Provider | GONZALEZ |
| First Name Of The Provider | MIGUEL |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1775 DEMPSTER ST |
| Street Address 2 Of The Provider | LUTHERAN GENERAL HOSPITAL / PATHOLOGY DEPARTMENT |
| City Of The Provider | PARK RIDGE |
| Zip Code Of The Provider | 600681143 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 2668 |
| Number Of Medicare Beneficiaries | 669 |
| Total Submitted Charge Amount | 614186 |
| Total Medicare Allowed Amount | 106488.51 |
| Total Medicare Payment Amount | 82160.76 |
| Total Medicare Standardized Payment Amount | 63929.22 |
| 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 | 29 |
| Number Of Medical Services | 2668 |
| Number Of Medicare Beneficiaries With Medical Services | 669 |
| Total Medical Submitted Charge Amount | 614186 |
| Total Medical Medicare Allowed Amount | 106488.51 |
| Total Medical Medicare Payment Amount | 82160.76 |
| Total Medical Medicare Standardized Payment Amount | 63929.22 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 280 |
| Number Of Beneficiaries Age 75 to 84 | 233 |
| Number Of Beneficiaries Age Greater 84 | 84 |
| Number Of Female Beneficiaries | 368 |
| Number Of Male Beneficiaries | 301 |
| Number Of Non Hispanic White Beneficiaries | 562 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 553 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 116 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5683 |