| National Provider Identifier [NPI]: | 1124138375 |
| Last Name Of The Provider | HENNINGSEN |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1700 W STOUT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICE LAKE |
| Zip Code Of The Provider | 548685000 |
| 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 | 93 |
| Number Of Services | 1103 |
| Number Of Medicare Beneficiaries | 318 |
| Total Submitted Charge Amount | 187803.36 |
| Total Medicare Allowed Amount | 76412.33 |
| Total Medicare Payment Amount | 54909.4 |
| Total Medicare Standardized Payment Amount | 57254.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 113 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 1868.11 |
| Total Drug Medicare AllowedAmount | 1529.71 |
| Total Drug Medicare PaymentAmount | 1426.29 |
| Total Drug Medicare Standardized Payment Amount | 1426.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 990 |
| Number Of Medicare Beneficiaries With Medical Services | 318 |
| Total Medical Submitted Charge Amount | 185935.25 |
| Total Medical Medicare Allowed Amount | 74882.62 |
| Total Medical Medicare Payment Amount | 53483.11 |
| Total Medical Medicare Standardized Payment Amount | 55827.97 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 111 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 158 |
| Number Of Non Hispanic White Beneficiaries | 304 |
| 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 | 202 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 116 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.139 |