| National Provider Identifier [NPI]: | 1588659171 |
| Last Name Of The Provider | HOLLISTER |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 725 AMERICAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WAUKESHA |
| Zip Code Of The Provider | 531885031 |
| 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 | 177 |
| Number Of Services | 6185 |
| Number Of Medicare Beneficiaries | 2831 |
| Total Submitted Charge Amount | 966351.5 |
| Total Medicare Allowed Amount | 168500.45 |
| Total Medicare Payment Amount | 129888.51 |
| Total Medicare Standardized Payment Amount | 135927.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1052 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 5048 |
| Total Drug Medicare AllowedAmount | 277.74 |
| Total Drug Medicare PaymentAmount | 217.75 |
| Total Drug Medicare Standardized Payment Amount | 217.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 175 |
| Number Of Medical Services | 5133 |
| Number Of Medicare Beneficiaries With Medical Services | 2831 |
| Total Medical Submitted Charge Amount | 961303.5 |
| Total Medical Medicare Allowed Amount | 168222.71 |
| Total Medical Medicare Payment Amount | 129670.76 |
| Total Medical Medicare Standardized Payment Amount | 135709.78 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 334 |
| Number Of Beneficiaries Age 65 to 74 | 1144 |
| Number Of Beneficiaries Age 75 to 84 | 862 |
| Number Of Beneficiaries Age Greater 84 | 491 |
| Number Of Female Beneficiaries | 1812 |
| Number Of Male Beneficiaries | 1019 |
| Number Of Non Hispanic White Beneficiaries | 2715 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2423 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 408 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4099 |