| National Provider Identifier [NPI]: | 1588617856 |
| Last Name Of The Provider | IACOB |
| First Name Of The Provider | MIRCEA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25 N WINFIELD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINFIELD |
| Zip Code Of The Provider | 601901295 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 5033 |
| Number Of Medicare Beneficiaries | 999 |
| Total Submitted Charge Amount | 617019 |
| Total Medicare Allowed Amount | 285230.62 |
| Total Medicare Payment Amount | 211716.84 |
| Total Medicare Standardized Payment Amount | 205025.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2810 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 39410 |
| Total Drug Medicare AllowedAmount | 15429.13 |
| Total Drug Medicare PaymentAmount | 12096.41 |
| Total Drug Medicare Standardized Payment Amount | 12096.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 2223 |
| Number Of Medicare Beneficiaries With Medical Services | 998 |
| Total Medical Submitted Charge Amount | 577609 |
| Total Medical Medicare Allowed Amount | 269801.49 |
| Total Medical Medicare Payment Amount | 199620.43 |
| Total Medical Medicare Standardized Payment Amount | 192929.48 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 350 |
| Number Of Beneficiaries Age 75 to 84 | 297 |
| Number Of Beneficiaries Age Greater 84 | 181 |
| Number Of Female Beneficiaries | 561 |
| Number Of Male Beneficiaries | 438 |
| Number Of Non Hispanic White Beneficiaries | 874 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 806 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 193 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 19 |
| Percent Of With Stroke | 42 |
| Average HCC Risk Score Of Beneficiaries | 1.5882 |