| National Provider Identifier [NPI]: | 1700996238 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | KELLEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 N OAK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARSHFIELD |
| Zip Code Of The Provider | 544495777 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 2861 |
| Number Of Medicare Beneficiaries | 1608 |
| Total Submitted Charge Amount | 1875488.3 |
| Total Medicare Allowed Amount | 190428.06 |
| Total Medicare Payment Amount | 141950.48 |
| Total Medicare Standardized Payment Amount | 148716.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 126 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 21680.8 |
| Total Drug Medicare AllowedAmount | 6216.9 |
| Total Drug Medicare PaymentAmount | 4874.2 |
| Total Drug Medicare Standardized Payment Amount | 4874.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 2735 |
| Number Of Medicare Beneficiaries With Medical Services | 1608 |
| Total Medical Submitted Charge Amount | 1853807.5 |
| Total Medical Medicare Allowed Amount | 184211.16 |
| Total Medical Medicare Payment Amount | 137076.28 |
| Total Medical Medicare Standardized Payment Amount | 143842.08 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 249 |
| Number Of Beneficiaries Age 65 to 74 | 504 |
| Number Of Beneficiaries Age 75 to 84 | 506 |
| Number Of Beneficiaries Age Greater 84 | 349 |
| Number Of Female Beneficiaries | 785 |
| Number Of Male Beneficiaries | 823 |
| Number Of Non Hispanic White Beneficiaries | 1545 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1137 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 471 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8301 |