| National Provider Identifier [NPI]: | 1992737522 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 E CAPITOL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | APPLETON |
| Zip Code Of The Provider | 549118735 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 278 |
| Number Of Services | 19820 |
| Number Of Medicare Beneficiaries | 2018 |
| Total Submitted Charge Amount | 1613304.13 |
| Total Medicare Allowed Amount | 409929.6 |
| Total Medicare Payment Amount | 326196.82 |
| Total Medicare Standardized Payment Amount | 339635.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 9317 |
| Number Of Medicare Beneficiaries With Drug Services | 291 |
| Total Drug Submitted ChargeAmount | 15645.41 |
| Total Drug Medicare AllowedAmount | 8960.67 |
| Total Drug Medicare PaymentAmount | 7866.56 |
| Total Drug Medicare Standardized Payment Amount | 7866.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 265 |
| Number Of Medical Services | 10503 |
| Number Of Medicare Beneficiaries With Medical Services | 2017 |
| Total Medical Submitted Charge Amount | 1597658.72 |
| Total Medical Medicare Allowed Amount | 400968.93 |
| Total Medical Medicare Payment Amount | 318330.26 |
| Total Medical Medicare Standardized Payment Amount | 331768.48 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 338 |
| Number Of Beneficiaries Age 65 to 74 | 831 |
| Number Of Beneficiaries Age 75 to 84 | 536 |
| Number Of Beneficiaries Age Greater 84 | 313 |
| Number Of Female Beneficiaries | 1237 |
| Number Of Male Beneficiaries | 781 |
| Number Of Non Hispanic White Beneficiaries | 1922 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1663 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 355 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2021 |