| National Provider Identifier [NPI]: | 1508046418 |
| Last Name Of The Provider | BORMAN |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10400 W NORTH AVENUE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 53226 |
| 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 | 173 |
| Number Of Services | 7810 |
| Number Of Medicare Beneficiaries | 2696 |
| Total Submitted Charge Amount | 2099793 |
| Total Medicare Allowed Amount | 223742.07 |
| Total Medicare Payment Amount | 166767.22 |
| Total Medicare Standardized Payment Amount | 177547.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 3120 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 7697 |
| Total Drug Medicare AllowedAmount | 889.51 |
| Total Drug Medicare PaymentAmount | 678.95 |
| Total Drug Medicare Standardized Payment Amount | 678.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 169 |
| Number Of Medical Services | 4690 |
| Number Of Medicare Beneficiaries With Medical Services | 2696 |
| Total Medical Submitted Charge Amount | 2092096 |
| Total Medical Medicare Allowed Amount | 222852.56 |
| Total Medical Medicare Payment Amount | 166088.27 |
| Total Medical Medicare Standardized Payment Amount | 176868.86 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 508 |
| Number Of Beneficiaries Age 65 to 74 | 1040 |
| Number Of Beneficiaries Age 75 to 84 | 737 |
| Number Of Beneficiaries Age Greater 84 | 411 |
| Number Of Female Beneficiaries | 1650 |
| Number Of Male Beneficiaries | 1046 |
| Number Of Non Hispanic White Beneficiaries | 2586 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 24 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2093 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 603 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2463 |