| National Provider Identifier [NPI]: | 1467526400 |
| Last Name Of The Provider | ANTONNEAU |
| First Name Of The Provider | KIRSTEN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1515 S GREENBAY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | RACINE |
| Zip Code Of The Provider | 534064409 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 2632 |
| Number Of Medicare Beneficiaries | 640 |
| Total Submitted Charge Amount | 482386.13 |
| Total Medicare Allowed Amount | 124030.78 |
| Total Medicare Payment Amount | 88136.41 |
| Total Medicare Standardized Payment Amount | 108323.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 121 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 3176.21 |
| Total Drug Medicare AllowedAmount | 1191.79 |
| Total Drug Medicare PaymentAmount | 926.19 |
| Total Drug Medicare Standardized Payment Amount | 926.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 2511 |
| Number Of Medicare Beneficiaries With Medical Services | 640 |
| Total Medical Submitted Charge Amount | 479209.92 |
| Total Medical Medicare Allowed Amount | 122838.99 |
| Total Medical Medicare Payment Amount | 87210.22 |
| Total Medical Medicare Standardized Payment Amount | 107397.78 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 297 |
| Number Of Beneficiaries Age 75 to 84 | 160 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 403 |
| Number Of Male Beneficiaries | 237 |
| Number Of Non Hispanic White Beneficiaries | 578 |
| Number Of Black or African American Beneficiaries | 36 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 557 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9817 |