| National Provider Identifier [NPI]: | 1427049063 |
| Last Name Of The Provider | COLLISTER |
| First Name Of The Provider | BETH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 360 S MOUNTIN DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MAYVILLE |
| Zip Code Of The Provider | 530501498 |
| 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 | 54 |
| Number Of Services | 657 |
| Number Of Medicare Beneficiaries | 122 |
| Total Submitted Charge Amount | 120127 |
| Total Medicare Allowed Amount | 44899.55 |
| Total Medicare Payment Amount | 32731.35 |
| Total Medicare Standardized Payment Amount | 34674.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 2050 |
| Total Drug Medicare AllowedAmount | 1628.92 |
| Total Drug Medicare PaymentAmount | 1503.09 |
| Total Drug Medicare Standardized Payment Amount | 1503.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 589 |
| Number Of Medicare Beneficiaries With Medical Services | 122 |
| Total Medical Submitted Charge Amount | 118077 |
| Total Medical Medicare Allowed Amount | 43270.63 |
| Total Medical Medicare Payment Amount | 31228.26 |
| Total Medical Medicare Standardized Payment Amount | 33171.65 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 29 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7894 |