National Provider Identifier [NPI]: |
1801902069 |
Last Name Of The Provider |
HANSON |
First Name Of The Provider |
WILLIAM |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3221 STEIN BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
EAU CLAIRE |
Zip Code Of The Provider |
54701 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
434 |
Number Of Medicare Beneficiaries |
109 |
Total Submitted Charge Amount |
63824 |
Total Medicare Allowed Amount |
19191.89 |
Total Medicare Payment Amount |
12982.03 |
Total Medicare Standardized Payment Amount |
13804.2 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
17 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
1471 |
Total Drug Medicare AllowedAmount |
561.38 |
Total Drug Medicare PaymentAmount |
550.14 |
Total Drug Medicare Standardized Payment Amount |
550.14 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
21 |
Number Of Medical Services |
417 |
Number Of Medicare Beneficiaries With Medical Services |
109 |
Total Medical Submitted Charge Amount |
62353 |
Total Medical Medicare Allowed Amount |
18630.51 |
Total Medical Medicare Payment Amount |
12431.89 |
Total Medical Medicare Standardized Payment Amount |
13254.06 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
43 |
Number Of Beneficiaries Age 75 to 84 |
42 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
32 |
Number Of Male Beneficiaries |
77 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9044 |