| National Provider Identifier [NPI]: | 1295820546 |
| Last Name Of The Provider | HEIDEMAN |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9601 TOWNLINE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MINOCQUA |
| Zip Code Of The Provider | 545489099 |
| 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 | 200 |
| Number Of Services | 26443 |
| Number Of Medicare Beneficiaries | 3569 |
| Total Submitted Charge Amount | 2875953.2 |
| Total Medicare Allowed Amount | 433224.76 |
| Total Medicare Payment Amount | 331724.05 |
| Total Medicare Standardized Payment Amount | 343229.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 20483 |
| Number Of Medicare Beneficiaries With Drug Services | 233 |
| Total Drug Submitted ChargeAmount | 26338.8 |
| Total Drug Medicare AllowedAmount | 5243.57 |
| Total Drug Medicare PaymentAmount | 4008.28 |
| Total Drug Medicare Standardized Payment Amount | 4008.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 196 |
| Number Of Medical Services | 5960 |
| Number Of Medicare Beneficiaries With Medical Services | 3556 |
| Total Medical Submitted Charge Amount | 2849614.4 |
| Total Medical Medicare Allowed Amount | 427981.19 |
| Total Medical Medicare Payment Amount | 327715.77 |
| Total Medical Medicare Standardized Payment Amount | 339221.4 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 606 |
| Number Of Beneficiaries Age 65 to 74 | 1404 |
| Number Of Beneficiaries Age 75 to 84 | 1084 |
| Number Of Beneficiaries Age Greater 84 | 475 |
| Number Of Female Beneficiaries | 2040 |
| Number Of Male Beneficiaries | 1529 |
| Number Of Non Hispanic White Beneficiaries | 3337 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | 71 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2707 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 862 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5665 |