| National Provider Identifier [NPI]: | 1427042423 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3329 N RICHMOND ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | APPLETON |
| Zip Code Of The Provider | 549111063 |
| 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 | 112 |
| Number Of Services | 5732 |
| Number Of Medicare Beneficiaries | 2577 |
| Total Submitted Charge Amount | 551135 |
| Total Medicare Allowed Amount | 116841.91 |
| Total Medicare Payment Amount | 80056.72 |
| Total Medicare Standardized Payment Amount | 84981.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1289 |
| Total Drug Medicare AllowedAmount | 734.61 |
| Total Drug Medicare PaymentAmount | 711.09 |
| Total Drug Medicare Standardized Payment Amount | 711.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 104 |
| Number Of Medical Services | 5710 |
| Number Of Medicare Beneficiaries With Medical Services | 2577 |
| Total Medical Submitted Charge Amount | 549846 |
| Total Medical Medicare Allowed Amount | 116107.3 |
| Total Medical Medicare Payment Amount | 79345.63 |
| Total Medical Medicare Standardized Payment Amount | 84269.97 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 716 |
| Number Of Beneficiaries Age 65 to 74 | 861 |
| Number Of Beneficiaries Age 75 to 84 | 636 |
| Number Of Beneficiaries Age Greater 84 | 364 |
| Number Of Female Beneficiaries | 1530 |
| Number Of Male Beneficiaries | 1047 |
| Number Of Non Hispanic White Beneficiaries | 2402 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1805 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 772 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1927 |