| National Provider Identifier [NPI]: | 1487645842 |
| Last Name Of The Provider | STEFANCIW |
| First Name Of The Provider | WAYNE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3922 CEDAR RUN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TRAVERSE CITY |
| Zip Code Of The Provider | 496849687 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 3166 |
| Number Of Medicare Beneficiaries | 618 |
| Total Submitted Charge Amount | 332185.58 |
| Total Medicare Allowed Amount | 185586.91 |
| Total Medicare Payment Amount | 135535.56 |
| Total Medicare Standardized Payment Amount | 141914.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 476 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 22233 |
| Total Drug Medicare AllowedAmount | 18243.6 |
| Total Drug Medicare PaymentAmount | 14259.68 |
| Total Drug Medicare Standardized Payment Amount | 14259.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2690 |
| Number Of Medicare Beneficiaries With Medical Services | 618 |
| Total Medical Submitted Charge Amount | 309952.58 |
| Total Medical Medicare Allowed Amount | 167343.31 |
| Total Medical Medicare Payment Amount | 121275.88 |
| Total Medical Medicare Standardized Payment Amount | 127654.68 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 211 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 105 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 468 |
| Number Of Non Hispanic White Beneficiaries | 606 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 558 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1241 |