| National Provider Identifier [NPI]: | 1659306041 |
| Last Name Of The Provider | CHELMOWSKI |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3003 W GOOD HOPE ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 53209 |
| 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 | 102 |
| Number Of Services | 6318 |
| Number Of Medicare Beneficiaries | 810 |
| Total Submitted Charge Amount | 884965.07 |
| Total Medicare Allowed Amount | 251983.04 |
| Total Medicare Payment Amount | 196506.04 |
| Total Medicare Standardized Payment Amount | 206347.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 829 |
| Number Of Medicare Beneficiaries With Drug Services | 283 |
| Total Drug Submitted ChargeAmount | 32718.07 |
| Total Drug Medicare AllowedAmount | 9906.11 |
| Total Drug Medicare PaymentAmount | 9166.87 |
| Total Drug Medicare Standardized Payment Amount | 9166.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 5489 |
| Number Of Medicare Beneficiaries With Medical Services | 809 |
| Total Medical Submitted Charge Amount | 852247 |
| Total Medical Medicare Allowed Amount | 242076.93 |
| Total Medical Medicare Payment Amount | 187339.17 |
| Total Medical Medicare Standardized Payment Amount | 197180.91 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 339 |
| Number Of Beneficiaries Age 75 to 84 | 240 |
| Number Of Beneficiaries Age Greater 84 | 160 |
| Number Of Female Beneficiaries | 410 |
| Number Of Male Beneficiaries | 400 |
| Number Of Non Hispanic White Beneficiaries | 658 |
| Number Of Black or African American Beneficiaries | 121 |
| 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 | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 747 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0827 |