| National Provider Identifier [NPI]: | 1992885354 |
| Last Name Of The Provider | BODENSTEINER |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1700 W PARADISE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST BEND |
| Zip Code Of The Provider | 530959795 |
| 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 | 61 |
| Number Of Services | 990 |
| Number Of Medicare Beneficiaries | 345 |
| Total Submitted Charge Amount | 221510.95 |
| Total Medicare Allowed Amount | 69475.72 |
| Total Medicare Payment Amount | 44162.45 |
| Total Medicare Standardized Payment Amount | 46717.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 110 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 6744.34 |
| Total Drug Medicare AllowedAmount | 2469.42 |
| Total Drug Medicare PaymentAmount | 2358.44 |
| Total Drug Medicare Standardized Payment Amount | 2358.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 880 |
| Number Of Medicare Beneficiaries With Medical Services | 345 |
| Total Medical Submitted Charge Amount | 214766.61 |
| Total Medical Medicare Allowed Amount | 67006.3 |
| Total Medical Medicare Payment Amount | 41804.01 |
| Total Medical Medicare Standardized Payment Amount | 44359.55 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 168 |
| Number Of Beneficiaries Age 75 to 84 | 89 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 160 |
| Number Of Non Hispanic White Beneficiaries | 332 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9587 |