| National Provider Identifier [NPI]: | 1508835596 |
| Last Name Of The Provider | STEPHERSON |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 202 S PARK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 53715 |
| 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 | 174 |
| Number Of Services | 8161 |
| Number Of Medicare Beneficiaries | 2969 |
| Total Submitted Charge Amount | 1367230.72 |
| Total Medicare Allowed Amount | 247626.24 |
| Total Medicare Payment Amount | 186663.29 |
| Total Medicare Standardized Payment Amount | 192598.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 3992 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 4415.5 |
| Total Drug Medicare AllowedAmount | 948.63 |
| Total Drug Medicare PaymentAmount | 740.94 |
| Total Drug Medicare Standardized Payment Amount | 740.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 170 |
| Number Of Medical Services | 4169 |
| Number Of Medicare Beneficiaries With Medical Services | 2969 |
| Total Medical Submitted Charge Amount | 1362815.22 |
| Total Medical Medicare Allowed Amount | 246677.61 |
| Total Medical Medicare Payment Amount | 185922.35 |
| Total Medical Medicare Standardized Payment Amount | 191857.58 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 492 |
| Number Of Beneficiaries Age 65 to 74 | 1193 |
| Number Of Beneficiaries Age 75 to 84 | 842 |
| Number Of Beneficiaries Age Greater 84 | 442 |
| Number Of Female Beneficiaries | 1854 |
| Number Of Male Beneficiaries | 1115 |
| Number Of Non Hispanic White Beneficiaries | 2774 |
| Number Of Black or African American Beneficiaries | 78 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2335 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 634 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3071 |