| National Provider Identifier [NPI]: | 1215126503 |
| Last Name Of The Provider | SO |
| First Name Of The Provider | MATHEW |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3501 CRANBERRY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WESTON |
| Zip Code Of The Provider | 544765213 |
| 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 | 143 |
| Number Of Services | 6708 |
| Number Of Medicare Beneficiaries | 2223 |
| Total Submitted Charge Amount | 1230360.6 |
| Total Medicare Allowed Amount | 141461.38 |
| Total Medicare Payment Amount | 104297.91 |
| Total Medicare Standardized Payment Amount | 110451.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 3544 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 4639.6 |
| Total Drug Medicare AllowedAmount | 1011.2 |
| Total Drug Medicare PaymentAmount | 755.74 |
| Total Drug Medicare Standardized Payment Amount | 755.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 140 |
| Number Of Medical Services | 3164 |
| Number Of Medicare Beneficiaries With Medical Services | 2221 |
| Total Medical Submitted Charge Amount | 1225721 |
| Total Medical Medicare Allowed Amount | 140450.18 |
| Total Medical Medicare Payment Amount | 103542.17 |
| Total Medical Medicare Standardized Payment Amount | 109696.2 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 457 |
| Number Of Beneficiaries Age 65 to 74 | 860 |
| Number Of Beneficiaries Age 75 to 84 | 615 |
| Number Of Beneficiaries Age Greater 84 | 291 |
| Number Of Female Beneficiaries | 1251 |
| Number Of Male Beneficiaries | 972 |
| Number Of Non Hispanic White Beneficiaries | 2096 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 42 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 34 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1538 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 685 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6433 |