| National Provider Identifier [NPI]: | 1508088485 |
| Last Name Of The Provider | VARGHESE |
| First Name Of The Provider | SHINEY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | RN, ND, APN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 731 S ILLINOIS ROUTE 21 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GURNEE |
| Zip Code Of The Provider | 600313813 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 395 |
| Number Of Medicare Beneficiaries | 202 |
| Total Submitted Charge Amount | 13797.45 |
| Total Medicare Allowed Amount | 13130.06 |
| Total Medicare Payment Amount | 11601.83 |
| Total Medicare Standardized Payment Amount | 12662.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 160 |
| Number Of Medicare Beneficiaries With Drug Services | 155 |
| Total Drug Submitted ChargeAmount | 4569.45 |
| Total Drug Medicare AllowedAmount | 4569.45 |
| Total Drug Medicare PaymentAmount | 4477.03 |
| Total Drug Medicare Standardized Payment Amount | 4477.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 235 |
| Number Of Medicare Beneficiaries With Medical Services | 202 |
| Total Medical Submitted Charge Amount | 9228 |
| Total Medical Medicare Allowed Amount | 8560.61 |
| Total Medical Medicare Payment Amount | 7124.8 |
| Total Medical Medicare Standardized Payment Amount | 8185.01 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 130 |
| Number Of Beneficiaries Age 75 to 84 | 56 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 186 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 5 |
| Percent Of With Diabetes | 11 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 10 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7438 |