| National Provider Identifier [NPI]: | 1356386270 |
| Last Name Of The Provider | MODDER |
| First Name Of The Provider | JOSHUA |
| 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 | SUITE 2600 |
| 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 | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 2368 |
| Number Of Medicare Beneficiaries | 385 |
| Total Submitted Charge Amount | 693204.5 |
| Total Medicare Allowed Amount | 151736.87 |
| Total Medicare Payment Amount | 114074.68 |
| Total Medicare Standardized Payment Amount | 118623.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 992 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 87247 |
| Total Drug Medicare AllowedAmount | 46065.09 |
| Total Drug Medicare PaymentAmount | 35939.86 |
| Total Drug Medicare Standardized Payment Amount | 35939.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 1376 |
| Number Of Medicare Beneficiaries With Medical Services | 385 |
| Total Medical Submitted Charge Amount | 605957.5 |
| Total Medical Medicare Allowed Amount | 105671.78 |
| Total Medical Medicare Payment Amount | 78134.82 |
| Total Medical Medicare Standardized Payment Amount | 82684.08 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 154 |
| Number Of Beneficiaries Age 75 to 84 | 109 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 266 |
| Number Of Non Hispanic White Beneficiaries | 362 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 299 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3212 |