| National Provider Identifier [NPI]: | 1417396524 |
| Last Name Of The Provider | CLARK-SELTZNER |
| First Name Of The Provider | MACKENZIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | APNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5395 E CHERYL PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | FITCHBURG |
| Zip Code Of The Provider | 537115395 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 1864 |
| Number Of Medicare Beneficiaries | 62 |
| Total Submitted Charge Amount | 84796.91 |
| Total Medicare Allowed Amount | 39734.6 |
| Total Medicare Payment Amount | 31005.58 |
| Total Medicare Standardized Payment Amount | 34047.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 1661 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 45126.25 |
| Total Drug Medicare AllowedAmount | 21300.49 |
| Total Drug Medicare PaymentAmount | 16706.13 |
| Total Drug Medicare Standardized Payment Amount | 16706.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 203 |
| Number Of Medicare Beneficiaries With Medical Services | 62 |
| Total Medical Submitted Charge Amount | 39670.66 |
| Total Medical Medicare Allowed Amount | 18434.11 |
| Total Medical Medicare Payment Amount | 14299.45 |
| Total Medical Medicare Standardized Payment Amount | 17341.71 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 15 |
| Number Of Beneficiaries Age 75 to 84 | 15 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 21 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 55 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 21 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.1099 |