| National Provider Identifier [NPI]: | 1538276068 |
| Last Name Of The Provider | KENT |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 PARK RIDGE LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH FOND DU LAC |
| Zip Code Of The Provider | 54937 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 883 |
| Number Of Medicare Beneficiaries | 178 |
| Total Submitted Charge Amount | 149841.4 |
| Total Medicare Allowed Amount | 46266.08 |
| Total Medicare Payment Amount | 34579.27 |
| Total Medicare Standardized Payment Amount | 37423.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 55 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 2258.4 |
| Total Drug Medicare AllowedAmount | 1131.8 |
| Total Drug Medicare PaymentAmount | 1090.22 |
| Total Drug Medicare Standardized Payment Amount | 1090.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 828 |
| Number Of Medicare Beneficiaries With Medical Services | 178 |
| Total Medical Submitted Charge Amount | 147583 |
| Total Medical Medicare Allowed Amount | 45134.28 |
| Total Medical Medicare Payment Amount | 33489.05 |
| Total Medical Medicare Standardized Payment Amount | 36332.94 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 92 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 126 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0539 |