| National Provider Identifier [NPI]: | 1023087319 |
| Last Name Of The Provider | CLUTSON |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 116 MONROE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEAVER DAM |
| Zip Code Of The Provider | 539162437 |
| 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 | 174 |
| Number Of Services | 5957 |
| Number Of Medicare Beneficiaries | 2467 |
| Total Submitted Charge Amount | 547670.6 |
| Total Medicare Allowed Amount | 196304.21 |
| Total Medicare Payment Amount | 154320.17 |
| Total Medicare Standardized Payment Amount | 149229.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2112 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 2475.6 |
| Total Drug Medicare AllowedAmount | 713.33 |
| Total Drug Medicare PaymentAmount | 559.22 |
| Total Drug Medicare Standardized Payment Amount | 559.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 172 |
| Number Of Medical Services | 3845 |
| Number Of Medicare Beneficiaries With Medical Services | 2467 |
| Total Medical Submitted Charge Amount | 545195 |
| Total Medical Medicare Allowed Amount | 195590.88 |
| Total Medical Medicare Payment Amount | 153760.95 |
| Total Medical Medicare Standardized Payment Amount | 148670.76 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 455 |
| Number Of Beneficiaries Age 65 to 74 | 1015 |
| Number Of Beneficiaries Age 75 to 84 | 653 |
| Number Of Beneficiaries Age Greater 84 | 344 |
| Number Of Female Beneficiaries | 1605 |
| Number Of Male Beneficiaries | 862 |
| Number Of Non Hispanic White Beneficiaries | 1569 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | 63 |
| Number Of Hispanic Beneficiaries | 752 |
| Number Of American Indian Alaska Native Beneficiaries | 27 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1477 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 990 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7268 |