| National Provider Identifier [NPI]: | 1508826801 |
| Last Name Of The Provider | KELCZ |
| First Name Of The Provider | FREDERICK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 600 HIGHLAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 53792 |
| 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 | 85 |
| Number Of Services | 3763 |
| Number Of Medicare Beneficiaries | 1526 |
| Total Submitted Charge Amount | 841480.44 |
| Total Medicare Allowed Amount | 115860.75 |
| Total Medicare Payment Amount | 90229.59 |
| Total Medicare Standardized Payment Amount | 94183.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1373 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 4461 |
| Total Drug Medicare AllowedAmount | 279.2 |
| Total Drug Medicare PaymentAmount | 218.91 |
| Total Drug Medicare Standardized Payment Amount | 218.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 2390 |
| Number Of Medicare Beneficiaries With Medical Services | 1526 |
| Total Medical Submitted Charge Amount | 837019.44 |
| Total Medical Medicare Allowed Amount | 115581.55 |
| Total Medical Medicare Payment Amount | 90010.68 |
| Total Medical Medicare Standardized Payment Amount | 93964.42 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 396 |
| Number Of Beneficiaries Age 65 to 74 | 684 |
| Number Of Beneficiaries Age 75 to 84 | 340 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 918 |
| Number Of Male Beneficiaries | 608 |
| Number Of Non Hispanic White Beneficiaries | 1369 |
| Number Of Black or African American Beneficiaries | 58 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1174 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 352 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.8722 |