| National Provider Identifier [NPI]: | 1407930886 |
| Last Name Of The Provider | SMALE |
| First Name Of The Provider | JEFFERY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3200 PLEASANT VALLEY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST BEND |
| Zip Code Of The Provider | 530959274 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 2744 |
| Number Of Medicare Beneficiaries | 675 |
| Total Submitted Charge Amount | 683008.81 |
| Total Medicare Allowed Amount | 195136.2 |
| Total Medicare Payment Amount | 146970.47 |
| Total Medicare Standardized Payment Amount | 153367.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 3854.63 |
| Total Drug Medicare AllowedAmount | 1515.6 |
| Total Drug Medicare PaymentAmount | 1459.35 |
| Total Drug Medicare Standardized Payment Amount | 1459.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 2676 |
| Number Of Medicare Beneficiaries With Medical Services | 675 |
| Total Medical Submitted Charge Amount | 679154.18 |
| Total Medical Medicare Allowed Amount | 193620.6 |
| Total Medical Medicare Payment Amount | 145511.12 |
| Total Medical Medicare Standardized Payment Amount | 151908.44 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 106 |
| Number Of Beneficiaries Age 65 to 74 | 251 |
| Number Of Beneficiaries Age 75 to 84 | 229 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 356 |
| Number Of Male Beneficiaries | 319 |
| Number Of Non Hispanic White Beneficiaries | 658 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 562 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 25 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.6045 |