| National Provider Identifier [NPI]: | 1134297559 |
| Last Name Of The Provider | PELANT |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1024 N MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICE LAKE |
| Zip Code Of The Provider | 548680028 |
| 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 | 138 |
| Number Of Services | 3113 |
| Number Of Medicare Beneficiaries | 1686 |
| Total Submitted Charge Amount | 596578.65 |
| Total Medicare Allowed Amount | 99068.11 |
| Total Medicare Payment Amount | 80335.4 |
| Total Medicare Standardized Payment Amount | 84190.41 |
| 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 | 138 |
| Number Of Medical Services | 3113 |
| Number Of Medicare Beneficiaries With Medical Services | 1686 |
| Total Medical Submitted Charge Amount | 596578.65 |
| Total Medical Medicare Allowed Amount | 99068.11 |
| Total Medical Medicare Payment Amount | 80335.4 |
| Total Medical Medicare Standardized Payment Amount | 84190.41 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 280 |
| Number Of Beneficiaries Age 65 to 74 | 697 |
| Number Of Beneficiaries Age 75 to 84 | 469 |
| Number Of Beneficiaries Age Greater 84 | 240 |
| Number Of Female Beneficiaries | 1101 |
| Number Of Male Beneficiaries | 585 |
| Number Of Non Hispanic White Beneficiaries | 1565 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 98 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1190 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 496 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1559 |