| National Provider Identifier [NPI]: | 1053303057 |
| Last Name Of The Provider | GANNE |
| First Name Of The Provider | VASUNDHARA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3120 SOUTH 27TH STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 53215 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 4310 |
| Number Of Medicare Beneficiaries | 756 |
| Total Submitted Charge Amount | 1407247 |
| Total Medicare Allowed Amount | 440634.28 |
| Total Medicare Payment Amount | 334711.74 |
| Total Medicare Standardized Payment Amount | 354738.83 |
| 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 | 19 |
| Number Of Medical Services | 4310 |
| Number Of Medicare Beneficiaries With Medical Services | 756 |
| Total Medical Submitted Charge Amount | 1407247 |
| Total Medical Medicare Allowed Amount | 440634.28 |
| Total Medical Medicare Payment Amount | 334711.74 |
| Total Medical Medicare Standardized Payment Amount | 354738.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 197 |
| Number Of Beneficiaries Age 65 to 74 | 239 |
| Number Of Beneficiaries Age 75 to 84 | 224 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 378 |
| Number Of Male Beneficiaries | 378 |
| Number Of Non Hispanic White Beneficiaries | 541 |
| Number Of Black or African American Beneficiaries | 107 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 76 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 488 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 268 |
| Percent Of With Atrial Fibrillation | 30 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 66 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 4.4958 |