| National Provider Identifier [NPI]: | 1548467764 |
| Last Name Of The Provider | BASS |
| First Name Of The Provider | RYAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 945 N 12TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532331305 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 847 |
| Number Of Medicare Beneficiaries | 726 |
| Total Submitted Charge Amount | 745457 |
| Total Medicare Allowed Amount | 126553.67 |
| Total Medicare Payment Amount | 97733.86 |
| Total Medicare Standardized Payment Amount | 101614.62 |
| 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 | 27 |
| Number Of Medical Services | 847 |
| Number Of Medicare Beneficiaries With Medical Services | 726 |
| Total Medical Submitted Charge Amount | 745457 |
| Total Medical Medicare Allowed Amount | 126553.67 |
| Total Medical Medicare Payment Amount | 97733.86 |
| Total Medical Medicare Standardized Payment Amount | 101614.62 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 264 |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 398 |
| Number Of Male Beneficiaries | 328 |
| Number Of Non Hispanic White Beneficiaries | 635 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 317 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.946 |