National Provider Identifier [NPI]: |
1982672275 |
Last Name Of The Provider |
SHOLL |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9555 GROSS POINT RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
SKOKIE |
Zip Code Of The Provider |
600761356 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
71 |
Number Of Services |
2587 |
Number Of Medicare Beneficiaries |
401 |
Total Submitted Charge Amount |
482934.4 |
Total Medicare Allowed Amount |
171512.81 |
Total Medicare Payment Amount |
122710.28 |
Total Medicare Standardized Payment Amount |
116016.63 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
119 |
Number Of Medicare Beneficiaries With Drug Services |
108 |
Total Drug Submitted ChargeAmount |
7532 |
Total Drug Medicare AllowedAmount |
4958.53 |
Total Drug Medicare PaymentAmount |
4714.46 |
Total Drug Medicare Standardized Payment Amount |
4714.46 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
63 |
Number Of Medical Services |
2468 |
Number Of Medicare Beneficiaries With Medical Services |
401 |
Total Medical Submitted Charge Amount |
475402.4 |
Total Medical Medicare Allowed Amount |
166554.28 |
Total Medical Medicare Payment Amount |
117995.82 |
Total Medical Medicare Standardized Payment Amount |
111302.17 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
151 |
Number Of Beneficiaries Age 75 to 84 |
142 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
199 |
Number Of Male Beneficiaries |
202 |
Number Of Non Hispanic White Beneficiaries |
380 |
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 |
|
Number Of Beneficiaries With Medicare Only Entitlement |
387 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
15 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
61 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.1828 |