| National Provider Identifier [NPI]: | 1144258013 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 680 N LAKE SHORE DR |
| Street Address 2 Of The Provider | SUITE 1000 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606114546 |
| 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 | 67 |
| Number Of Services | 4220 |
| Number Of Medicare Beneficiaries | 3037 |
| Total Submitted Charge Amount | 1001016 |
| Total Medicare Allowed Amount | 191753.98 |
| Total Medicare Payment Amount | 144260.5 |
| Total Medicare Standardized Payment Amount | 136392 |
| 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 | 67 |
| Number Of Medical Services | 4220 |
| Number Of Medicare Beneficiaries With Medical Services | 3037 |
| Total Medical Submitted Charge Amount | 1001016 |
| Total Medical Medicare Allowed Amount | 191753.98 |
| Total Medical Medicare Payment Amount | 144260.5 |
| Total Medical Medicare Standardized Payment Amount | 136392 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 570 |
| Number Of Beneficiaries Age 65 to 74 | 1389 |
| Number Of Beneficiaries Age 75 to 84 | 805 |
| Number Of Beneficiaries Age Greater 84 | 273 |
| Number Of Female Beneficiaries | 1608 |
| Number Of Male Beneficiaries | 1429 |
| Number Of Non Hispanic White Beneficiaries | 2038 |
| Number Of Black or African American Beneficiaries | 616 |
| Number Of AsianPacific Islander Beneficiaries | 108 |
| Number Of Hispanic Beneficiaries | 218 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2354 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 683 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.978 |