National Provider Identifier [NPI]: |
1194012112 |
Last Name Of The Provider |
KAID |
First Name Of The Provider |
YOUSEF |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
M.D |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1653 W CONGRESS PKWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606123833 |
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 |
6 |
Number Of Services |
92 |
Number Of Medicare Beneficiaries |
89 |
Total Submitted Charge Amount |
63531 |
Total Medicare Allowed Amount |
15482.21 |
Total Medicare Payment Amount |
12137.84 |
Total Medicare Standardized Payment Amount |
11679.71 |
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 |
6 |
Number Of Medical Services |
92 |
Number Of Medicare Beneficiaries With Medical Services |
89 |
Total Medical Submitted Charge Amount |
63531 |
Total Medical Medicare Allowed Amount |
15482.21 |
Total Medical Medicare Payment Amount |
12137.84 |
Total Medical Medicare Standardized Payment Amount |
11679.71 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
26 |
Number Of Beneficiaries Age 65 to 74 |
23 |
Number Of Beneficiaries Age 75 to 84 |
24 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
46 |
Number Of Male Beneficiaries |
43 |
Number Of Non Hispanic White Beneficiaries |
77 |
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 |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
64 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
25 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
54 |
Percent Of With Chronic Kidney Disease |
60 |
Percent Of With Chronic Obstructive Pulmonary Disease |
55 |
Percent Of With Depression |
47 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
74 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
60 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.2982 |