| National Provider Identifier [NPI]: | 1841236445 |
| Last Name Of The Provider | GIDEONSEN |
| First Name Of The Provider | MARK |
| 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 | 617 W CLAIREMONT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAU CLAIRE |
| Zip Code Of The Provider | 547016223 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 1863 |
| Number Of Medicare Beneficiaries | 280 |
| Total Submitted Charge Amount | 150680 |
| Total Medicare Allowed Amount | 59075.3 |
| Total Medicare Payment Amount | 42327.28 |
| Total Medicare Standardized Payment Amount | 43761.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 546 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 5871 |
| Total Drug Medicare AllowedAmount | 2768.01 |
| Total Drug Medicare PaymentAmount | 2475.31 |
| Total Drug Medicare Standardized Payment Amount | 2475.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 1317 |
| Number Of Medicare Beneficiaries With Medical Services | 279 |
| Total Medical Submitted Charge Amount | 144809 |
| Total Medical Medicare Allowed Amount | 56307.29 |
| Total Medical Medicare Payment Amount | 39851.97 |
| Total Medical Medicare Standardized Payment Amount | 41286.23 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3932 |