| National Provider Identifier [NPI]: | 1619955937 |
| Last Name Of The Provider | TOLLY |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 325 N COMMERCIAL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEENAH |
| Zip Code Of The Provider | 549562665 |
| 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 | 155 |
| Number Of Services | 3010 |
| Number Of Medicare Beneficiaries | 1984 |
| Total Submitted Charge Amount | 542130 |
| Total Medicare Allowed Amount | 73240.58 |
| Total Medicare Payment Amount | 57339.87 |
| Total Medicare Standardized Payment Amount | 59877.29 |
| 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 | 155 |
| Number Of Medical Services | 3010 |
| Number Of Medicare Beneficiaries With Medical Services | 1984 |
| Total Medical Submitted Charge Amount | 542130 |
| Total Medical Medicare Allowed Amount | 73240.58 |
| Total Medical Medicare Payment Amount | 57339.87 |
| Total Medical Medicare Standardized Payment Amount | 59877.29 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 391 |
| Number Of Beneficiaries Age 65 to 74 | 689 |
| Number Of Beneficiaries Age 75 to 84 | 553 |
| Number Of Beneficiaries Age Greater 84 | 351 |
| Number Of Female Beneficiaries | 1333 |
| Number Of Male Beneficiaries | 651 |
| Number Of Non Hispanic White Beneficiaries | 1902 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1430 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 554 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4221 |