| National Provider Identifier [NPI]: | 1134370810 |
| Last Name Of The Provider | HASLETT |
| First Name Of The Provider | JEANETTE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 420 E DIVISION ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FOND DU LAC |
| Zip Code Of The Provider | 549354560 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 513 |
| Number Of Medicare Beneficiaries | 433 |
| Total Submitted Charge Amount | 291068 |
| Total Medicare Allowed Amount | 83066.68 |
| Total Medicare Payment Amount | 64435.75 |
| Total Medicare Standardized Payment Amount | 57365.49 |
| 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 | 20 |
| Number Of Medical Services | 513 |
| Number Of Medicare Beneficiaries With Medical Services | 433 |
| Total Medical Submitted Charge Amount | 291068 |
| Total Medical Medicare Allowed Amount | 83066.68 |
| Total Medical Medicare Payment Amount | 64435.75 |
| Total Medical Medicare Standardized Payment Amount | 57365.49 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 126 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 106 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 249 |
| Number Of Male Beneficiaries | 184 |
| Number Of Non Hispanic White Beneficiaries | 61 |
| Number Of Black or African American Beneficiaries | 262 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 84 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 348 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 40 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.8403 |