| National Provider Identifier [NPI]: | 1821092420 |
| Last Name Of The Provider | BOSTANCHE |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6123 GREEN BAY RD |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | KENOSHA |
| Zip Code Of The Provider | 531422939 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 3752 |
| Number Of Medicare Beneficiaries | 926 |
| Total Submitted Charge Amount | 408176 |
| Total Medicare Allowed Amount | 189485.36 |
| Total Medicare Payment Amount | 136452.46 |
| Total Medicare Standardized Payment Amount | 142479.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 860 |
| Number Of Medicare Beneficiaries With Drug Services | 98 |
| Total Drug Submitted ChargeAmount | 10320 |
| Total Drug Medicare AllowedAmount | 1527.7 |
| Total Drug Medicare PaymentAmount | 1103.9 |
| Total Drug Medicare Standardized Payment Amount | 1103.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 2892 |
| Number Of Medicare Beneficiaries With Medical Services | 926 |
| Total Medical Submitted Charge Amount | 397856 |
| Total Medical Medicare Allowed Amount | 187957.66 |
| Total Medical Medicare Payment Amount | 135348.56 |
| Total Medical Medicare Standardized Payment Amount | 141375.71 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 177 |
| Number Of Beneficiaries Age 65 to 74 | 319 |
| Number Of Beneficiaries Age 75 to 84 | 238 |
| Number Of Beneficiaries Age Greater 84 | 192 |
| Number Of Female Beneficiaries | 561 |
| Number Of Male Beneficiaries | 365 |
| Number Of Non Hispanic White Beneficiaries | 788 |
| Number Of Black or African American Beneficiaries | 87 |
| 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 | 688 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 238 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.378 |