National Provider Identifier [NPI]: |
1043266307 |
Last Name Of The Provider |
TEMPLE |
First Name Of The Provider |
LESLIE |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2400 CHESTNUT AVE |
Street Address 2 Of The Provider |
SUITE A |
City Of The Provider |
GLENVIEW |
Zip Code Of The Provider |
600268321 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
4 |
Number Of Services |
547 |
Number Of Medicare Beneficiaries |
307 |
Total Submitted Charge Amount |
78993 |
Total Medicare Allowed Amount |
55076.18 |
Total Medicare Payment Amount |
39850.94 |
Total Medicare Standardized Payment Amount |
37228.91 |
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 |
4 |
Number Of Medical Services |
547 |
Number Of Medicare Beneficiaries With Medical Services |
307 |
Total Medical Submitted Charge Amount |
78993 |
Total Medical Medicare Allowed Amount |
55076.18 |
Total Medical Medicare Payment Amount |
39850.94 |
Total Medical Medicare Standardized Payment Amount |
37228.91 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
158 |
Number Of Beneficiaries Age 75 to 84 |
98 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
244 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
275 |
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 |
11 |
Number Of Beneficiaries With Medicare Only Entitlement |
282 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
25 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
10 |
Percent Of With Cancer |
23 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
14 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
45 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
21 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1643 |