| National Provider Identifier [NPI]: | 1194741389 |
| Last Name Of The Provider | GRAY |
| First Name Of The Provider | DANA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2900 W OKLAHOMA AVENUE |
| Street Address 2 Of The Provider | ST LUKES HOSPITAL RADIOLOGY DEPARTMENT |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532012901 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 172 |
| Number Of Services | 3260 |
| Number Of Medicare Beneficiaries | 2329 |
| Total Submitted Charge Amount | 602937.95 |
| Total Medicare Allowed Amount | 94085.25 |
| Total Medicare Payment Amount | 69455.72 |
| Total Medicare Standardized Payment Amount | 72748.82 |
| 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 | 172 |
| Number Of Medical Services | 3260 |
| Number Of Medicare Beneficiaries With Medical Services | 2329 |
| Total Medical Submitted Charge Amount | 602937.95 |
| Total Medical Medicare Allowed Amount | 94085.25 |
| Total Medical Medicare Payment Amount | 69455.72 |
| Total Medical Medicare Standardized Payment Amount | 72748.82 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 490 |
| Number Of Beneficiaries Age 65 to 74 | 754 |
| Number Of Beneficiaries Age 75 to 84 | 626 |
| Number Of Beneficiaries Age Greater 84 | 459 |
| Number Of Female Beneficiaries | 1405 |
| Number Of Male Beneficiaries | 924 |
| Number Of Non Hispanic White Beneficiaries | 1918 |
| Number Of Black or African American Beneficiaries | 244 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 127 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1687 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 642 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8466 |