| National Provider Identifier [NPI]: | 1831139823 |
| Last Name Of The Provider | FALLICO |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 BIESTERFIELD RD |
| Street Address 2 Of The Provider | ELK GROVE RADIOLOGY |
| City Of The Provider | ELK GROVE VLG |
| Zip Code Of The Provider | 600073311 |
| 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 | 199 |
| Number Of Services | 7969 |
| Number Of Medicare Beneficiaries | 4555 |
| Total Submitted Charge Amount | 1018067 |
| Total Medicare Allowed Amount | 285447.73 |
| Total Medicare Payment Amount | 222830.09 |
| Total Medicare Standardized Payment Amount | 209775.68 |
| 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 | 199 |
| Number Of Medical Services | 7969 |
| Number Of Medicare Beneficiaries With Medical Services | 4555 |
| Total Medical Submitted Charge Amount | 1018067 |
| Total Medical Medicare Allowed Amount | 285447.73 |
| Total Medical Medicare Payment Amount | 222830.09 |
| Total Medical Medicare Standardized Payment Amount | 209775.68 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 458 |
| Number Of Beneficiaries Age 65 to 74 | 1724 |
| Number Of Beneficiaries Age 75 to 84 | 1535 |
| Number Of Beneficiaries Age Greater 84 | 838 |
| Number Of Female Beneficiaries | 2894 |
| Number Of Male Beneficiaries | 1661 |
| Number Of Non Hispanic White Beneficiaries | 3949 |
| Number Of Black or African American Beneficiaries | 87 |
| Number Of AsianPacific Islander Beneficiaries | 226 |
| Number Of Hispanic Beneficiaries | 226 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 67 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3748 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 807 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6556 |