| National Provider Identifier [NPI]: | 1073790804 |
| Last Name Of The Provider | EDLEBECK |
| First Name Of The Provider | ANNA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21700 INTERTECH DR |
| Street Address 2 Of The Provider | SPRINGDALE HEALTH CENTER |
| City Of The Provider | BROOKFIELD |
| Zip Code Of The Provider | 530455197 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 578 |
| Number Of Medicare Beneficiaries | 134 |
| Total Submitted Charge Amount | 125643.76 |
| Total Medicare Allowed Amount | 40620.09 |
| Total Medicare Payment Amount | 29489.22 |
| Total Medicare Standardized Payment Amount | 31496.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 92 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 3487.85 |
| Total Drug Medicare AllowedAmount | 2200.11 |
| Total Drug Medicare PaymentAmount | 2122.48 |
| Total Drug Medicare Standardized Payment Amount | 2122.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 486 |
| Number Of Medicare Beneficiaries With Medical Services | 134 |
| Total Medical Submitted Charge Amount | 122155.91 |
| Total Medical Medicare Allowed Amount | 38419.98 |
| Total Medical Medicare Payment Amount | 27366.74 |
| Total Medical Medicare Standardized Payment Amount | 29373.95 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 98 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 120 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 110 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.99 |