| National Provider Identifier [NPI]: | 1104913854 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | LEE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104 TRINITY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILLIPS |
| Zip Code Of The Provider | 54555 |
| 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 | 116 |
| Number Of Services | 5162 |
| Number Of Medicare Beneficiaries | 443 |
| Total Submitted Charge Amount | 266123.8 |
| Total Medicare Allowed Amount | 104249.94 |
| Total Medicare Payment Amount | 73072.1 |
| Total Medicare Standardized Payment Amount | 76292.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 23 |
| Number Of Drug Services | 3291 |
| Number Of Medicare Beneficiaries With Drug Services | 209 |
| Total Drug Submitted ChargeAmount | 43067.4 |
| Total Drug Medicare AllowedAmount | 20532.01 |
| Total Drug Medicare PaymentAmount | 16694.58 |
| Total Drug Medicare Standardized Payment Amount | 16694.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 1871 |
| Number Of Medicare Beneficiaries With Medical Services | 442 |
| Total Medical Submitted Charge Amount | 223056.4 |
| Total Medical Medicare Allowed Amount | 83717.93 |
| Total Medical Medicare Payment Amount | 56377.52 |
| Total Medical Medicare Standardized Payment Amount | 59597.77 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 103 |
| Number Of Beneficiaries Age 65 to 74 | 170 |
| Number Of Beneficiaries Age 75 to 84 | 102 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 253 |
| Number Of Male Beneficiaries | 190 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 291 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 152 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1636 |