| National Provider Identifier [NPI]: | 1962579243 |
| Last Name Of The Provider | PENCIKOWSKI |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 810 LIEBMAN CT |
| Street Address 2 Of The Provider | APT 8 |
| City Of The Provider | GREEN BAY |
| Zip Code Of The Provider | 543025090 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 282 |
| Number Of Medicare Beneficiaries | 175 |
| Total Submitted Charge Amount | 51948.06 |
| Total Medicare Allowed Amount | 14851.06 |
| Total Medicare Payment Amount | 9056.87 |
| Total Medicare Standardized Payment Amount | 11669.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1348.52 |
| Total Drug Medicare AllowedAmount | 465.35 |
| Total Drug Medicare PaymentAmount | 333.87 |
| Total Drug Medicare Standardized Payment Amount | 333.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 246 |
| Number Of Medicare Beneficiaries With Medical Services | 174 |
| Total Medical Submitted Charge Amount | 50599.54 |
| Total Medical Medicare Allowed Amount | 14385.71 |
| Total Medical Medicare Payment Amount | 8723 |
| Total Medical Medicare Standardized Payment Amount | 11335.33 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 80 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 101 |
| Number Of Male Beneficiaries | 74 |
| 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 | 154 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9192 |