| National Provider Identifier [NPI]: | 1578582474 |
| Last Name Of The Provider | DISANTI |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 109 SOUTH GENOA STREET |
| Street Address 2 Of The Provider | GENOA MEDICAL CLINIC |
| City Of The Provider | GENOA |
| Zip Code Of The Provider | 60135 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 2486 |
| Number Of Medicare Beneficiaries | 294 |
| Total Submitted Charge Amount | 226788.5 |
| Total Medicare Allowed Amount | 180911.75 |
| Total Medicare Payment Amount | 133851.32 |
| Total Medicare Standardized Payment Amount | 139551.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 61 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 1534 |
| Total Drug Medicare AllowedAmount | 627.62 |
| Total Drug Medicare PaymentAmount | 597.31 |
| Total Drug Medicare Standardized Payment Amount | 597.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 2425 |
| Number Of Medicare Beneficiaries With Medical Services | 294 |
| Total Medical Submitted Charge Amount | 225254.5 |
| Total Medical Medicare Allowed Amount | 180284.13 |
| Total Medical Medicare Payment Amount | 133254.01 |
| Total Medical Medicare Standardized Payment Amount | 138954.55 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 130 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 44 |
| Number Of Female Beneficiaries | 156 |
| Number Of Male Beneficiaries | 138 |
| Number Of Non Hispanic White Beneficiaries | 280 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 262 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1543 |