| National Provider Identifier [NPI]: | 1982677969 |
| Last Name Of The Provider | WOOLEVER |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 240 MAPLE AVE |
| Street Address 2 Of The Provider | PROHEALTH CARE MEDICAL ASSOCIATES INC |
| City Of The Provider | MUKWONAGO |
| Zip Code Of The Provider | 531498475 |
| 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 | 55 |
| Number Of Services | 1833 |
| Number Of Medicare Beneficiaries | 234 |
| Total Submitted Charge Amount | 220704 |
| Total Medicare Allowed Amount | 85900.34 |
| Total Medicare Payment Amount | 59995.5 |
| Total Medicare Standardized Payment Amount | 62995.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 151 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 4671 |
| Total Drug Medicare AllowedAmount | 2605.02 |
| Total Drug Medicare PaymentAmount | 2458.21 |
| Total Drug Medicare Standardized Payment Amount | 2458.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 1682 |
| Number Of Medicare Beneficiaries With Medical Services | 234 |
| Total Medical Submitted Charge Amount | 216033 |
| Total Medical Medicare Allowed Amount | 83295.32 |
| Total Medical Medicare Payment Amount | 57537.29 |
| Total Medical Medicare Standardized Payment Amount | 60536.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 102 |
| Number Of Male Beneficiaries | 132 |
| 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 | 207 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1721 |