| National Provider Identifier [NPI]: | 1649293952 |
| Last Name Of The Provider | WHITE |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6451 E RIVERSIDE BLVD |
| Street Address 2 Of The Provider | STE 104 |
| City Of The Provider | ROCKFORD |
| Zip Code Of The Provider | 611144421 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 4468 |
| Number Of Medicare Beneficiaries | 1392 |
| Total Submitted Charge Amount | 260294.44 |
| Total Medicare Allowed Amount | 244210.62 |
| Total Medicare Payment Amount | 168018.79 |
| Total Medicare Standardized Payment Amount | 177290.18 |
| 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 | 34 |
| Number Of Medical Services | 4468 |
| Number Of Medicare Beneficiaries With Medical Services | 1392 |
| Total Medical Submitted Charge Amount | 260294.44 |
| Total Medical Medicare Allowed Amount | 244210.62 |
| Total Medical Medicare Payment Amount | 168018.79 |
| Total Medical Medicare Standardized Payment Amount | 177290.18 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 393 |
| Number Of Beneficiaries Age 75 to 84 | 554 |
| Number Of Beneficiaries Age Greater 84 | 363 |
| Number Of Female Beneficiaries | 831 |
| Number Of Male Beneficiaries | 561 |
| Number Of Non Hispanic White Beneficiaries | 1285 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1280 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 112 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3457 |