| National Provider Identifier [NPI]: | 1588853758 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | RORY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2414 KOHLER MEMORIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHEBOYGAN |
| Zip Code Of The Provider | 530813129 |
| 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 | 185 |
| Number Of Services | 13425 |
| Number Of Medicare Beneficiaries | 2224 |
| Total Submitted Charge Amount | 2764939 |
| Total Medicare Allowed Amount | 294075.34 |
| Total Medicare Payment Amount | 228877.1 |
| Total Medicare Standardized Payment Amount | 244816.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 9655 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 20065 |
| Total Drug Medicare AllowedAmount | 2191.84 |
| Total Drug Medicare PaymentAmount | 1629.24 |
| Total Drug Medicare Standardized Payment Amount | 1629.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 3770 |
| Number Of Medicare Beneficiaries With Medical Services | 2224 |
| Total Medical Submitted Charge Amount | 2744874 |
| Total Medical Medicare Allowed Amount | 291883.5 |
| Total Medical Medicare Payment Amount | 227247.86 |
| Total Medical Medicare Standardized Payment Amount | 243187.5 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 394 |
| Number Of Beneficiaries Age 65 to 74 | 959 |
| Number Of Beneficiaries Age 75 to 84 | 561 |
| Number Of Beneficiaries Age Greater 84 | 310 |
| Number Of Female Beneficiaries | 1477 |
| Number Of Male Beneficiaries | 747 |
| Number Of Non Hispanic White Beneficiaries | 2094 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 47 |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1780 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 444 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.235 |