| National Provider Identifier [NPI]: | 1184654725 |
| Last Name Of The Provider | JORGENSEN |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13133 N PORT WASHINGTON RD |
| Street Address 2 Of The Provider | SUITE G18 |
| City Of The Provider | MEQUON |
| Zip Code Of The Provider | 530972419 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Preventive Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 131 |
| Number Of Services | 3370 |
| Number Of Medicare Beneficiaries | 611 |
| Total Submitted Charge Amount | 469046.95 |
| Total Medicare Allowed Amount | 171972.02 |
| Total Medicare Payment Amount | 126011.76 |
| Total Medicare Standardized Payment Amount | 130761.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 155 |
| Number Of Medicare Beneficiaries With Drug Services | 141 |
| Total Drug Submitted ChargeAmount | 7763 |
| Total Drug Medicare AllowedAmount | 4396.25 |
| Total Drug Medicare PaymentAmount | 4292.95 |
| Total Drug Medicare Standardized Payment Amount | 4292.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 124 |
| Number Of Medical Services | 3215 |
| Number Of Medicare Beneficiaries With Medical Services | 609 |
| Total Medical Submitted Charge Amount | 461283.95 |
| Total Medical Medicare Allowed Amount | 167575.77 |
| Total Medical Medicare Payment Amount | 121718.81 |
| Total Medical Medicare Standardized Payment Amount | 126468.71 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 248 |
| Number Of Beneficiaries Age 75 to 84 | 215 |
| Number Of Beneficiaries Age Greater 84 | 129 |
| Number Of Female Beneficiaries | 332 |
| Number Of Male Beneficiaries | 279 |
| Number Of Non Hispanic White Beneficiaries | 577 |
| 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 | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 593 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9594 |