| National Provider Identifier [NPI]: | 1437188091 |
| Last Name Of The Provider | VANDERLIJN |
| First Name Of The Provider | PIETER |
| 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 | 1512 HIGH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICE LAKE |
| Zip Code Of The Provider | 548681875 |
| 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 | 141 |
| Number Of Services | 2745 |
| Number Of Medicare Beneficiaries | 1438 |
| Total Submitted Charge Amount | 307274 |
| Total Medicare Allowed Amount | 71688.71 |
| Total Medicare Payment Amount | 57234.77 |
| Total Medicare Standardized Payment Amount | 60182.99 |
| 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 | 141 |
| Number Of Medical Services | 2745 |
| Number Of Medicare Beneficiaries With Medical Services | 1438 |
| Total Medical Submitted Charge Amount | 307274 |
| Total Medical Medicare Allowed Amount | 71688.71 |
| Total Medical Medicare Payment Amount | 57234.77 |
| Total Medical Medicare Standardized Payment Amount | 60182.99 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 299 |
| Number Of Beneficiaries Age 65 to 74 | 492 |
| Number Of Beneficiaries Age 75 to 84 | 413 |
| Number Of Beneficiaries Age Greater 84 | 234 |
| Number Of Female Beneficiaries | 934 |
| Number Of Male Beneficiaries | 504 |
| Number Of Non Hispanic White Beneficiaries | 1390 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1058 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 380 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.353 |