National Provider Identifier [NPI]: |
1578599684 |
Last Name Of The Provider |
HEBL |
First Name Of The Provider |
BRIAN |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2500 E ENTERPRISE AVE |
Street Address 2 Of The Provider |
UNIT C |
City Of The Provider |
APPLETON |
Zip Code Of The Provider |
54913 |
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 |
121 |
Number Of Services |
2098 |
Number Of Medicare Beneficiaries |
1405 |
Total Submitted Charge Amount |
380377.85 |
Total Medicare Allowed Amount |
45219.99 |
Total Medicare Payment Amount |
35532.72 |
Total Medicare Standardized Payment Amount |
36863.26 |
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 |
121 |
Number Of Medical Services |
2098 |
Number Of Medicare Beneficiaries With Medical Services |
1405 |
Total Medical Submitted Charge Amount |
380377.85 |
Total Medical Medicare Allowed Amount |
45219.99 |
Total Medical Medicare Payment Amount |
35532.72 |
Total Medical Medicare Standardized Payment Amount |
36863.26 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
249 |
Number Of Beneficiaries Age 65 to 74 |
534 |
Number Of Beneficiaries Age 75 to 84 |
395 |
Number Of Beneficiaries Age Greater 84 |
227 |
Number Of Female Beneficiaries |
868 |
Number Of Male Beneficiaries |
537 |
Number Of Non Hispanic White Beneficiaries |
1263 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
19 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
84 |
Number Of Beneficiaries With Race Not Else where Classified |
20 |
Number Of Beneficiaries With Medicare Only Entitlement |
1083 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
322 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
27 |
Percent Of With Chronic Kidney Disease |
32 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.3814 |