| National Provider Identifier [NPI]: | 1164494217 |
| Last Name Of The Provider | DAHL |
| First Name Of The Provider | DANA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 403 STAGELINE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HUDSON |
| Zip Code Of The Provider | 54016 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 392 |
| Number Of Medicare Beneficiaries | 118 |
| Total Submitted Charge Amount | 34080.99 |
| Total Medicare Allowed Amount | 15586.43 |
| Total Medicare Payment Amount | 10520.09 |
| Total Medicare Standardized Payment Amount | 11943.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1023.58 |
| Total Drug Medicare AllowedAmount | 817 |
| Total Drug Medicare PaymentAmount | 798.57 |
| Total Drug Medicare Standardized Payment Amount | 798.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 361 |
| Number Of Medicare Beneficiaries With Medical Services | 118 |
| Total Medical Submitted Charge Amount | 33057.41 |
| Total Medical Medicare Allowed Amount | 14769.43 |
| Total Medical Medicare Payment Amount | 9721.52 |
| Total Medical Medicare Standardized Payment Amount | 11145.38 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 77 |
| Number Of Male Beneficiaries | 41 |
| 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 | 105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 9 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.753 |