| National Provider Identifier [NPI]: | 1053398818 |
| Last Name Of The Provider | SELINE |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | H |
| 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 | 153 |
| Number Of Services | 2165 |
| Number Of Medicare Beneficiaries | 1359 |
| Total Submitted Charge Amount | 590895.96 |
| Total Medicare Allowed Amount | 73614.4 |
| Total Medicare Payment Amount | 54879.37 |
| Total Medicare Standardized Payment Amount | 57575.61 |
| Drug Suppress Indicator | * |
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| Number Of Medicare Beneficiaries With Drug Services | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 332 |
| Number Of Beneficiaries Age 65 to 74 | 416 |
| Number Of Beneficiaries Age 75 to 84 | 362 |
| Number Of Beneficiaries Age Greater 84 | 249 |
| Number Of Female Beneficiaries | 797 |
| Number Of Male Beneficiaries | 562 |
| Number Of Non Hispanic White Beneficiaries | 1286 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 933 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 426 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4182 |