| National Provider Identifier [NPI]: | 1306865639 |
| Last Name Of The Provider | SIMON |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7435 W TALCOTT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606313707 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 270 |
| Number Of Services | 3891 |
| Number Of Medicare Beneficiaries | 2317 |
| Total Submitted Charge Amount | 938258.28 |
| Total Medicare Allowed Amount | 214464.76 |
| Total Medicare Payment Amount | 166308.73 |
| Total Medicare Standardized Payment Amount | 155345.73 |
| 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 | 270 |
| Number Of Medical Services | 3891 |
| Number Of Medicare Beneficiaries With Medical Services | 2317 |
| Total Medical Submitted Charge Amount | 938258.28 |
| Total Medical Medicare Allowed Amount | 214464.76 |
| Total Medical Medicare Payment Amount | 166308.73 |
| Total Medical Medicare Standardized Payment Amount | 155345.73 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 178 |
| Number Of Beneficiaries Age 65 to 74 | 608 |
| Number Of Beneficiaries Age 75 to 84 | 819 |
| Number Of Beneficiaries Age Greater 84 | 712 |
| Number Of Female Beneficiaries | 1412 |
| Number Of Male Beneficiaries | 905 |
| Number Of Non Hispanic White Beneficiaries | 2080 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 138 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1819 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 498 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9848 |