| National Provider Identifier [NPI]: | 1053578682 |
| Last Name Of The Provider | DERKSEN |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2105 E ENTERPRISE AVE |
| Street Address 2 Of The Provider | SUITE 111 |
| City Of The Provider | APPLETON |
| Zip Code Of The Provider | 549137862 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 762 |
| Number Of Medicare Beneficiaries | 162 |
| Total Submitted Charge Amount | 463181 |
| Total Medicare Allowed Amount | 78946.84 |
| Total Medicare Payment Amount | 59103 |
| Total Medicare Standardized Payment Amount | 62601.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 83 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 2301 |
| Total Drug Medicare AllowedAmount | 1605.02 |
| Total Drug Medicare PaymentAmount | 1245.43 |
| Total Drug Medicare Standardized Payment Amount | 1245.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 679 |
| Number Of Medicare Beneficiaries With Medical Services | 162 |
| Total Medical Submitted Charge Amount | 460880 |
| Total Medical Medicare Allowed Amount | 77341.82 |
| Total Medical Medicare Payment Amount | 57857.57 |
| Total Medical Medicare Standardized Payment Amount | 61355.74 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 84 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 99 |
| Number Of Male Beneficiaries | 63 |
| 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 | 133 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1463 |