| National Provider Identifier [NPI]: | 1427255447 |
| Last Name Of The Provider | LATTA |
| First Name Of The Provider | SHADI |
| 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 | 1775 W DEMPSTER ST |
| Street Address 2 Of The Provider | ADVOCATE LUTHERAN GENERAL HOSPITAL |
| 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 | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 38052 |
| Number Of Medicare Beneficiaries | 327 |
| Total Submitted Charge Amount | 1415058 |
| Total Medicare Allowed Amount | 651248.11 |
| Total Medicare Payment Amount | 512828.23 |
| Total Medicare Standardized Payment Amount | 503862.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 50 |
| Number Of Drug Services | 35153 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 1024200 |
| Total Drug Medicare AllowedAmount | 478641.84 |
| Total Drug Medicare PaymentAmount | 374917.24 |
| Total Drug Medicare Standardized Payment Amount | 374917.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 2899 |
| Number Of Medicare Beneficiaries With Medical Services | 326 |
| Total Medical Submitted Charge Amount | 390858 |
| Total Medical Medicare Allowed Amount | 172606.27 |
| Total Medical Medicare Payment Amount | 137910.99 |
| Total Medical Medicare Standardized Payment Amount | 128945.12 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 125 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 149 |
| Number Of Non Hispanic White Beneficiaries | 305 |
| Number Of Black or African American Beneficiaries | |
| 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 | 303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 39 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.9013 |