| National Provider Identifier [NPI]: | 1003076142 |
| Last Name Of The Provider | LACY |
| First Name Of The Provider | SHANON |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8901 W LINCOLN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST ALLIS |
| Zip Code Of The Provider | 532272409 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 3933 |
| Number Of Medicare Beneficiaries | 2211 |
| Total Submitted Charge Amount | 914212 |
| Total Medicare Allowed Amount | 137299.67 |
| Total Medicare Payment Amount | 103520.08 |
| Total Medicare Standardized Payment Amount | 83858.19 |
| 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 | 11 |
| Number Of Medical Services | 3933 |
| Number Of Medicare Beneficiaries With Medical Services | 2211 |
| Total Medical Submitted Charge Amount | 914212 |
| Total Medical Medicare Allowed Amount | 137299.67 |
| Total Medical Medicare Payment Amount | 103520.08 |
| Total Medical Medicare Standardized Payment Amount | 83858.19 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 860 |
| Number Of Beneficiaries Age 75 to 84 | 760 |
| Number Of Beneficiaries Age Greater 84 | 440 |
| Number Of Female Beneficiaries | 1096 |
| Number Of Male Beneficiaries | 1115 |
| Number Of Non Hispanic White Beneficiaries | 2120 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2033 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 178 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0971 |