| National Provider Identifier [NPI]: | 1922036797 |
| Last Name Of The Provider | RUBIO |
| First Name Of The Provider | NOEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5322 W FULLERTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606391425 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1044 |
| Number Of Medicare Beneficiaries | 276 |
| Total Submitted Charge Amount | 188046 |
| Total Medicare Allowed Amount | 80562.3 |
| Total Medicare Payment Amount | 52922.17 |
| Total Medicare Standardized Payment Amount | 51025.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 75 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 4117 |
| Total Drug Medicare AllowedAmount | 3474.55 |
| Total Drug Medicare PaymentAmount | 3404.98 |
| Total Drug Medicare Standardized Payment Amount | 3404.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 969 |
| Number Of Medicare Beneficiaries With Medical Services | 276 |
| Total Medical Submitted Charge Amount | 183929 |
| Total Medical Medicare Allowed Amount | 77087.75 |
| Total Medical Medicare Payment Amount | 49517.19 |
| Total Medical Medicare Standardized Payment Amount | 47620.59 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 112 |
| Number Of Beneficiaries Age 65 to 74 | 100 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 145 |
| Number Of Male Beneficiaries | 131 |
| Number Of Non Hispanic White Beneficiaries | 54 |
| Number Of Black or African American Beneficiaries | 58 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 142 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 91 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 185 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 25 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4486 |