| National Provider Identifier [NPI]: | 1497839617 |
| Last Name Of The Provider | DUBOIS |
| First Name Of The Provider | MELISSA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9200 W WISCONSIN AVE |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532263522 |
| 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 | 140 |
| Number Of Services | 8961 |
| Number Of Medicare Beneficiaries | 2859 |
| Total Submitted Charge Amount | 707880.38 |
| Total Medicare Allowed Amount | 109873.66 |
| Total Medicare Payment Amount | 84457.64 |
| Total Medicare Standardized Payment Amount | 89040.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3551 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 11861.14 |
| Total Drug Medicare AllowedAmount | 633.21 |
| Total Drug Medicare PaymentAmount | 443.32 |
| Total Drug Medicare Standardized Payment Amount | 443.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 5410 |
| Number Of Medicare Beneficiaries With Medical Services | 2858 |
| Total Medical Submitted Charge Amount | 696019.24 |
| Total Medical Medicare Allowed Amount | 109240.45 |
| Total Medical Medicare Payment Amount | 84014.32 |
| Total Medical Medicare Standardized Payment Amount | 88597.34 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 707 |
| Number Of Beneficiaries Age 65 to 74 | 1030 |
| Number Of Beneficiaries Age 75 to 84 | 728 |
| Number Of Beneficiaries Age Greater 84 | 394 |
| Number Of Female Beneficiaries | 1794 |
| Number Of Male Beneficiaries | 1065 |
| Number Of Non Hispanic White Beneficiaries | 2255 |
| Number Of Black or African American Beneficiaries | 462 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 73 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2057 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 802 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8592 |