| National Provider Identifier [NPI]: | 1912912213 |
| Last Name Of The Provider | HANNA |
| First Name Of The Provider | VAUGHN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 120 NE GLEN OAK AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616034314 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 2969 |
| Number Of Medicare Beneficiaries | 631 |
| Total Submitted Charge Amount | 210117.6 |
| Total Medicare Allowed Amount | 117818.7 |
| Total Medicare Payment Amount | 78438.5 |
| Total Medicare Standardized Payment Amount | 80883.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1419 |
| Number Of Medicare Beneficiaries With Drug Services | 167 |
| Total Drug Submitted ChargeAmount | 12055.6 |
| Total Drug Medicare AllowedAmount | 6231.1 |
| Total Drug Medicare PaymentAmount | 4584.47 |
| Total Drug Medicare Standardized Payment Amount | 4584.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 1550 |
| Number Of Medicare Beneficiaries With Medical Services | 631 |
| Total Medical Submitted Charge Amount | 198062 |
| Total Medical Medicare Allowed Amount | 111587.6 |
| Total Medical Medicare Payment Amount | 73854.03 |
| Total Medical Medicare Standardized Payment Amount | 76299.51 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 155 |
| Number Of Beneficiaries Age 65 to 74 | 295 |
| Number Of Beneficiaries Age 75 to 84 | 139 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 475 |
| Number Of Male Beneficiaries | 156 |
| Number Of Non Hispanic White Beneficiaries | 566 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 507 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 124 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1181 |