| National Provider Identifier [NPI]: | 1760431076 |
| Last Name Of The Provider | EDELSTEIN |
| First Name Of The Provider | VADIM |
| 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 | 4555 OAKTON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SKOKIE |
| Zip Code Of The Provider | 600763178 |
| 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 | 55 |
| Number Of Services | 7218 |
| Number Of Medicare Beneficiaries | 738 |
| Total Submitted Charge Amount | 603951.15 |
| Total Medicare Allowed Amount | 387320.32 |
| Total Medicare Payment Amount | 313315.42 |
| Total Medicare Standardized Payment Amount | 295407.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 301 |
| Number Of Medicare Beneficiaries With Drug Services | 205 |
| Total Drug Submitted ChargeAmount | 9943 |
| Total Drug Medicare AllowedAmount | 7772.07 |
| Total Drug Medicare PaymentAmount | 7497.62 |
| Total Drug Medicare Standardized Payment Amount | 7497.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 6917 |
| Number Of Medicare Beneficiaries With Medical Services | 738 |
| Total Medical Submitted Charge Amount | 594008.15 |
| Total Medical Medicare Allowed Amount | 379548.25 |
| Total Medical Medicare Payment Amount | 305817.8 |
| Total Medical Medicare Standardized Payment Amount | 287909.96 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 208 |
| Number Of Beneficiaries Age 75 to 84 | 279 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 393 |
| Number Of Male Beneficiaries | 345 |
| Number Of Non Hispanic White Beneficiaries | 673 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 261 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 477 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6632 |