| National Provider Identifier [NPI]: | 1730135146 |
| Last Name Of The Provider | BONEBRAKE |
| First Name Of The Provider | FRANK |
| 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 | 2817 NEW PINERY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTAGE |
| Zip Code Of The Provider | 539019240 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 929 |
| Number Of Medicare Beneficiaries | 364 |
| Total Submitted Charge Amount | 184620 |
| Total Medicare Allowed Amount | 48609.5 |
| Total Medicare Payment Amount | 35379.92 |
| Total Medicare Standardized Payment Amount | 36707.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 593 |
| Total Drug Medicare AllowedAmount | 34.32 |
| Total Drug Medicare PaymentAmount | 29.35 |
| Total Drug Medicare Standardized Payment Amount | 29.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 898 |
| Number Of Medicare Beneficiaries With Medical Services | 364 |
| Total Medical Submitted Charge Amount | 184027 |
| Total Medical Medicare Allowed Amount | 48575.18 |
| Total Medical Medicare Payment Amount | 35350.57 |
| Total Medical Medicare Standardized Payment Amount | 36678.61 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 180 |
| Number Of Male Beneficiaries | 184 |
| Number Of Non Hispanic White Beneficiaries | 352 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 247 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3161 |