| National Provider Identifier [NPI]: | 1376560334 |
| Last Name Of The Provider | BASHAM |
| First Name Of The Provider | MARK |
| 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 LAYTON 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 | 156 |
| Number Of Services | 2099 |
| Number Of Medicare Beneficiaries | 1638 |
| Total Submitted Charge Amount | 589571 |
| Total Medicare Allowed Amount | 86732.73 |
| Total Medicare Payment Amount | 65212.77 |
| Total Medicare Standardized Payment Amount | 68481.46 |
| 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 | 156 |
| Number Of Medical Services | 2099 |
| Number Of Medicare Beneficiaries With Medical Services | 1638 |
| Total Medical Submitted Charge Amount | 589571 |
| Total Medical Medicare Allowed Amount | 86732.73 |
| Total Medical Medicare Payment Amount | 65212.77 |
| Total Medical Medicare Standardized Payment Amount | 68481.46 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 366 |
| Number Of Beneficiaries Age 65 to 74 | 501 |
| Number Of Beneficiaries Age 75 to 84 | 474 |
| Number Of Beneficiaries Age Greater 84 | 297 |
| Number Of Female Beneficiaries | 929 |
| Number Of Male Beneficiaries | 709 |
| Number Of Non Hispanic White Beneficiaries | 1331 |
| Number Of Black or African American Beneficiaries | 168 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 92 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 538 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.0593 |