| National Provider Identifier [NPI]: | 1295752251 |
| Last Name Of The Provider | AMOLI |
| First Name Of The Provider | SEAN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6150 WEST LAYTON AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREENFIELD |
| Zip Code Of The Provider | 53220 |
| 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 | 170 |
| Number Of Services | 3679 |
| Number Of Medicare Beneficiaries | 2713 |
| Total Submitted Charge Amount | 941826 |
| Total Medicare Allowed Amount | 139184.57 |
| Total Medicare Payment Amount | 103145.71 |
| Total Medicare Standardized Payment Amount | 108520.94 |
| 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 | 170 |
| Number Of Medical Services | 3679 |
| Number Of Medicare Beneficiaries With Medical Services | 2713 |
| Total Medical Submitted Charge Amount | 941826 |
| Total Medical Medicare Allowed Amount | 139184.57 |
| Total Medical Medicare Payment Amount | 103145.71 |
| Total Medical Medicare Standardized Payment Amount | 108520.94 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 629 |
| Number Of Beneficiaries Age 65 to 74 | 805 |
| Number Of Beneficiaries Age 75 to 84 | 751 |
| Number Of Beneficiaries Age Greater 84 | 528 |
| Number Of Female Beneficiaries | 1562 |
| Number Of Male Beneficiaries | 1151 |
| Number Of Non Hispanic White Beneficiaries | 2238 |
| Number Of Black or African American Beneficiaries | 242 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 147 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1885 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 828 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9792 |