| National Provider Identifier [NPI]: | 1871537159 |
| Last Name Of The Provider | POWLEY |
| First Name Of The Provider | KENT |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 E ENTERPRISE AVE |
| Street Address 2 Of The Provider | UNIT C |
| City Of The Provider | APPLETON |
| Zip Code Of The Provider | 54913 |
| 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 | 117 |
| Number Of Services | 2232 |
| Number Of Medicare Beneficiaries | 1443 |
| Total Submitted Charge Amount | 382898 |
| Total Medicare Allowed Amount | 47270.91 |
| Total Medicare Payment Amount | 37339.29 |
| Total Medicare Standardized Payment Amount | 38721.43 |
| 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 | 117 |
| Number Of Medical Services | 2232 |
| Number Of Medicare Beneficiaries With Medical Services | 1443 |
| Total Medical Submitted Charge Amount | 382898 |
| Total Medical Medicare Allowed Amount | 47270.91 |
| Total Medical Medicare Payment Amount | 37339.29 |
| Total Medical Medicare Standardized Payment Amount | 38721.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 238 |
| Number Of Beneficiaries Age 65 to 74 | 582 |
| Number Of Beneficiaries Age 75 to 84 | 393 |
| Number Of Beneficiaries Age Greater 84 | 230 |
| Number Of Female Beneficiaries | 946 |
| Number Of Male Beneficiaries | 497 |
| Number Of Non Hispanic White Beneficiaries | 1339 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 63 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 314 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.346 |