| National Provider Identifier [NPI]: | 1306953278 |
| Last Name Of The Provider | WILFONG |
| First Name Of The Provider | SCOT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1475 W GRAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT WASHINGTON |
| Zip Code Of The Provider | 53074 |
| 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 | 81 |
| Number Of Services | 3468 |
| Number Of Medicare Beneficiaries | 304 |
| Total Submitted Charge Amount | 478417.51 |
| Total Medicare Allowed Amount | 140956.21 |
| Total Medicare Payment Amount | 107911.25 |
| Total Medicare Standardized Payment Amount | 114488.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 211 |
| Number Of Medicare Beneficiaries With Drug Services | 133 |
| Total Drug Submitted ChargeAmount | 10951.51 |
| Total Drug Medicare AllowedAmount | 5140.79 |
| Total Drug Medicare PaymentAmount | 4891.42 |
| Total Drug Medicare Standardized Payment Amount | 4891.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 3257 |
| Number Of Medicare Beneficiaries With Medical Services | 304 |
| Total Medical Submitted Charge Amount | 467466 |
| Total Medical Medicare Allowed Amount | 135815.42 |
| Total Medical Medicare Payment Amount | 103019.83 |
| Total Medical Medicare Standardized Payment Amount | 109596.85 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 126 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 54 |
| Number Of Female Beneficiaries | 171 |
| Number Of Male Beneficiaries | 133 |
| Number Of Non Hispanic White Beneficiaries | 291 |
| 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 | 274 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1326 |