| National Provider Identifier [NPI]: | 1679634844 |
| Last Name Of The Provider | HEILENBACH |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2650 RIDGE AVE |
| Street Address 2 Of The Provider | EVANSTON HOSPITAL |
| City Of The Provider | EVANSTON |
| Zip Code Of The Provider | 60201 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 1162 |
| Number Of Medicare Beneficiaries | 1006 |
| Total Submitted Charge Amount | 507583.63 |
| Total Medicare Allowed Amount | 178182.6 |
| Total Medicare Payment Amount | 133027.77 |
| Total Medicare Standardized Payment Amount | 124538.8 |
| 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 | 30 |
| Number Of Medical Services | 1162 |
| Number Of Medicare Beneficiaries With Medical Services | 1006 |
| Total Medical Submitted Charge Amount | 507583.63 |
| Total Medical Medicare Allowed Amount | 178182.6 |
| Total Medical Medicare Payment Amount | 133027.77 |
| Total Medical Medicare Standardized Payment Amount | 124538.8 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 139 |
| Number Of Beneficiaries Age 65 to 74 | 239 |
| Number Of Beneficiaries Age 75 to 84 | 331 |
| Number Of Beneficiaries Age Greater 84 | 297 |
| Number Of Female Beneficiaries | 590 |
| Number Of Male Beneficiaries | 416 |
| Number Of Non Hispanic White Beneficiaries | 858 |
| Number Of Black or African American Beneficiaries | 81 |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 800 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 206 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6982 |