| National Provider Identifier [NPI]: | 1992715395 |
| Last Name Of The Provider | PERSON |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9000 W WISCONSIN AVE |
| Street Address 2 Of The Provider | CHILDREN'S HOSPITAL OF WIS/ URGENT CARE |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532263518 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 1824 |
| Number Of Medicare Beneficiaries | 885 |
| Total Submitted Charge Amount | 64500.11 |
| Total Medicare Allowed Amount | 55948.61 |
| Total Medicare Payment Amount | 54745.97 |
| Total Medicare Standardized Payment Amount | 54623.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 941 |
| Number Of Medicare Beneficiaries With Drug Services | 884 |
| Total Drug Submitted ChargeAmount | 38010.11 |
| Total Drug Medicare AllowedAmount | 33679.35 |
| Total Drug Medicare PaymentAmount | 32942.91 |
| Total Drug Medicare Standardized Payment Amount | 32942.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 3 |
| Number Of Medical Services | 883 |
| Number Of Medicare Beneficiaries With Medical Services | 848 |
| Total Medical Submitted Charge Amount | 26490 |
| Total Medical Medicare Allowed Amount | 22269.26 |
| Total Medical Medicare Payment Amount | 21803.06 |
| Total Medical Medicare Standardized Payment Amount | 21680.57 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 318 |
| Number Of Beneficiaries Age 75 to 84 | 330 |
| Number Of Beneficiaries Age Greater 84 | 174 |
| Number Of Female Beneficiaries | 513 |
| Number Of Male Beneficiaries | 372 |
| Number Of Non Hispanic White Beneficiaries | 772 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 69 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 688 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 197 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0119 |