| National Provider Identifier [NPI]: | 1295727733 |
| Last Name Of The Provider | MARSHALL |
| First Name Of The Provider | ROLAND |
| Middle Initial Of The Provider | M |
| 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 | 25 |
| Number Of Services | 2054 |
| Number Of Medicare Beneficiaries | 833 |
| Total Submitted Charge Amount | 475559 |
| Total Medicare Allowed Amount | 75379.59 |
| Total Medicare Payment Amount | 57407.46 |
| Total Medicare Standardized Payment Amount | 42914.48 |
| 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 | 25 |
| Number Of Medical Services | 2054 |
| Number Of Medicare Beneficiaries With Medical Services | 833 |
| Total Medical Submitted Charge Amount | 475559 |
| Total Medical Medicare Allowed Amount | 75379.59 |
| Total Medical Medicare Payment Amount | 57407.46 |
| Total Medical Medicare Standardized Payment Amount | 42914.48 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 354 |
| Number Of Beneficiaries Age 75 to 84 | 258 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 503 |
| Number Of Male Beneficiaries | 330 |
| Number Of Non Hispanic White Beneficiaries | 547 |
| Number Of Black or African American Beneficiaries | 189 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 638 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 195 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.75 |