| National Provider Identifier [NPI]: | 1871536482 |
| Last Name Of The Provider | ULLRICK |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 W BROWN DEER RD |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | BAYSIDE |
| Zip Code Of The Provider | 532171627 |
| 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 | 148 |
| Number Of Services | 6080 |
| Number Of Medicare Beneficiaries | 2043 |
| Total Submitted Charge Amount | 663459.17 |
| Total Medicare Allowed Amount | 111333.13 |
| Total Medicare Payment Amount | 82745.72 |
| Total Medicare Standardized Payment Amount | 86612.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2906 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 10918.26 |
| Total Drug Medicare AllowedAmount | 568.85 |
| Total Drug Medicare PaymentAmount | 415.04 |
| Total Drug Medicare Standardized Payment Amount | 415.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 145 |
| Number Of Medical Services | 3174 |
| Number Of Medicare Beneficiaries With Medical Services | 2043 |
| Total Medical Submitted Charge Amount | 652540.91 |
| Total Medical Medicare Allowed Amount | 110764.28 |
| Total Medical Medicare Payment Amount | 82330.68 |
| Total Medical Medicare Standardized Payment Amount | 86197.38 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 294 |
| Number Of Beneficiaries Age 65 to 74 | 729 |
| Number Of Beneficiaries Age 75 to 84 | 628 |
| Number Of Beneficiaries Age Greater 84 | 392 |
| Number Of Female Beneficiaries | 1264 |
| Number Of Male Beneficiaries | 779 |
| Number Of Non Hispanic White Beneficiaries | 1794 |
| Number Of Black or African American Beneficiaries | 173 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1627 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 416 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5254 |