A provider with the NPI, 1912958778, could not be located.
1501 S CALIFORNIA AVE
CHICAGO, IL
NPI: 1912958778
Provider Type: Obstetrics/Gynecology
Entity Type: I
Psychiatric diagnostic evaluation
HCPCS Code: 90791
HCPCS product/service is a drug?: No
Place of Service: F
55
Number of Services
48
Number of Beneficiaries
$200.00
Average Submitted Charge
$124.85
Average Medicare Allowed Amount
$99.30
Average Medicare Payment
Group psychotherapy
HCPCS Code: 90853
HCPCS product/service is a drug?: No
Place of Service: F
8697
Number of Services
60
Number of Beneficiaries
$75.00
Average Submitted Charge
$26.37
Average Medicare Allowed Amount
$16.30
Average Medicare Payment