| National Provider Identifier [NPI]: | 1457395519 |
| Last Name Of The Provider | KNUDSON |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | J |
| 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 | 140 |
| Number Of Services | 1648 |
| Number Of Medicare Beneficiaries | 1148 |
| Total Submitted Charge Amount | 442121 |
| Total Medicare Allowed Amount | 52339 |
| Total Medicare Payment Amount | 40642.48 |
| Total Medicare Standardized Payment Amount | 42160.14 |
| 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 | 140 |
| Number Of Medical Services | 1648 |
| Number Of Medicare Beneficiaries With Medical Services | 1148 |
| Total Medical Submitted Charge Amount | 442121 |
| Total Medical Medicare Allowed Amount | 52339 |
| Total Medical Medicare Payment Amount | 40642.48 |
| Total Medical Medicare Standardized Payment Amount | 42160.14 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 223 |
| Number Of Beneficiaries Age 65 to 74 | 420 |
| Number Of Beneficiaries Age 75 to 84 | 329 |
| Number Of Beneficiaries Age Greater 84 | 176 |
| Number Of Female Beneficiaries | 697 |
| Number Of Male Beneficiaries | 451 |
| Number Of Non Hispanic White Beneficiaries | 1057 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 48 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 848 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 300 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4734 |