| National Provider Identifier [NPI]: | 1821019639 |
| Last Name Of The Provider | BLOOMGARDEN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6150 WEST LATYON 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 | 226 |
| Number Of Services | 3565 |
| Number Of Medicare Beneficiaries | 2390 |
| Total Submitted Charge Amount | 966938 |
| Total Medicare Allowed Amount | 149386.48 |
| Total Medicare Payment Amount | 113880.66 |
| Total Medicare Standardized Payment Amount | 120143.21 |
| 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 | 226 |
| Number Of Medical Services | 3565 |
| Number Of Medicare Beneficiaries With Medical Services | 2390 |
| Total Medical Submitted Charge Amount | 966938 |
| Total Medical Medicare Allowed Amount | 149386.48 |
| Total Medical Medicare Payment Amount | 113880.66 |
| Total Medical Medicare Standardized Payment Amount | 120143.21 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 491 |
| Number Of Beneficiaries Age 65 to 74 | 772 |
| Number Of Beneficiaries Age 75 to 84 | 684 |
| Number Of Beneficiaries Age Greater 84 | 443 |
| Number Of Female Beneficiaries | 1264 |
| Number Of Male Beneficiaries | 1126 |
| Number Of Non Hispanic White Beneficiaries | 1972 |
| Number Of Black or African American Beneficiaries | 245 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 108 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1725 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 665 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.2403 |