| National Provider Identifier [NPI]: | 1871575407 |
| Last Name Of The Provider | MORAL |
| First Name Of The Provider | GREGG |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 W BROWN DEER RD |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | BAYSIDE |
| Zip Code Of The Provider | 532171618 |
| 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 | 123 |
| Number Of Services | 6315 |
| Number Of Medicare Beneficiaries | 2930 |
| Total Submitted Charge Amount | 737900.09 |
| Total Medicare Allowed Amount | 158208.7 |
| Total Medicare Payment Amount | 129251.71 |
| Total Medicare Standardized Payment Amount | 134981.38 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
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| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
| Total Drug Medicare AllowedAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 390 |
| Number Of Beneficiaries Age 65 to 74 | 1104 |
| Number Of Beneficiaries Age 75 to 84 | 876 |
| Number Of Beneficiaries Age Greater 84 | 560 |
| Number Of Female Beneficiaries | 2017 |
| Number Of Male Beneficiaries | 913 |
| Number Of Non Hispanic White Beneficiaries | 2496 |
| Number Of Black or African American Beneficiaries | 323 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2392 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 538 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3685 |