| National Provider Identifier [NPI]: | 1477593036 |
| Last Name Of The Provider | BERENTSEN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3400 E RACINE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JANESVILLE |
| Zip Code Of The Provider | 535462344 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 10408 |
| Number Of Medicare Beneficiaries | 611 |
| Total Submitted Charge Amount | 826405.85 |
| Total Medicare Allowed Amount | 243425.67 |
| Total Medicare Payment Amount | 179954.98 |
| Total Medicare Standardized Payment Amount | 183425.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 7977 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 129503.75 |
| Total Drug Medicare AllowedAmount | 65583.15 |
| Total Drug Medicare PaymentAmount | 49891.08 |
| Total Drug Medicare Standardized Payment Amount | 49891.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 2431 |
| Number Of Medicare Beneficiaries With Medical Services | 611 |
| Total Medical Submitted Charge Amount | 696902.1 |
| Total Medical Medicare Allowed Amount | 177842.52 |
| Total Medical Medicare Payment Amount | 130063.9 |
| Total Medical Medicare Standardized Payment Amount | 133534.64 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 224 |
| Number Of Beneficiaries Age 65 to 74 | 190 |
| Number Of Beneficiaries Age 75 to 84 | 144 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 339 |
| Number Of Male Beneficiaries | 272 |
| Number Of Non Hispanic White Beneficiaries | 581 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 369 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 242 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.2151 |