| National Provider Identifier [NPI]: | 1306819479 |
| Last Name Of The Provider | ALLEN-GRYZWA |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 240 MAPLE AVE |
| Street Address 2 Of The Provider | PROHEALTH CARE MEDICAL ASSOCIATES INC. |
| City Of The Provider | MUKWONAGO |
| Zip Code Of The Provider | 531498475 |
| 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 | 47 |
| Number Of Services | 1311 |
| Number Of Medicare Beneficiaries | 194 |
| Total Submitted Charge Amount | 145031 |
| Total Medicare Allowed Amount | 65794.37 |
| Total Medicare Payment Amount | 46527.89 |
| Total Medicare Standardized Payment Amount | 48777.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 279 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 6333 |
| Total Drug Medicare AllowedAmount | 3916.47 |
| Total Drug Medicare PaymentAmount | 3801.53 |
| Total Drug Medicare Standardized Payment Amount | 3801.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 1032 |
| Number Of Medicare Beneficiaries With Medical Services | 194 |
| Total Medical Submitted Charge Amount | 138698 |
| Total Medical Medicare Allowed Amount | 61877.9 |
| Total Medical Medicare Payment Amount | 42726.36 |
| Total Medical Medicare Standardized Payment Amount | 44975.77 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 116 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 44 |
| 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 | 175 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8681 |