| National Provider Identifier [NPI]: | 1104840636 |
| Last Name Of The Provider | BLANKENSHIP |
| First Name Of The Provider | NANCY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2875 S 171ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW BERLIN |
| Zip Code Of The Provider | 531513511 |
| 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 | 151 |
| Number Of Services | 5002 |
| Number Of Medicare Beneficiaries | 3193 |
| Total Submitted Charge Amount | 1346963 |
| Total Medicare Allowed Amount | 147564.37 |
| Total Medicare Payment Amount | 110972.37 |
| Total Medicare Standardized Payment Amount | 117733.09 |
| 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 | 151 |
| Number Of Medical Services | 5002 |
| Number Of Medicare Beneficiaries With Medical Services | 3193 |
| Total Medical Submitted Charge Amount | 1346963 |
| Total Medical Medicare Allowed Amount | 147564.37 |
| Total Medical Medicare Payment Amount | 110972.37 |
| Total Medical Medicare Standardized Payment Amount | 117733.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 556 |
| Number Of Beneficiaries Age 65 to 74 | 1163 |
| Number Of Beneficiaries Age 75 to 84 | 923 |
| Number Of Beneficiaries Age Greater 84 | 551 |
| Number Of Female Beneficiaries | 2111 |
| Number Of Male Beneficiaries | 1082 |
| Number Of Non Hispanic White Beneficiaries | 2930 |
| Number Of Black or African American Beneficiaries | 123 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 89 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2443 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 750 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4819 |