| National Provider Identifier [NPI]: | 1720051824 |
| Last Name Of The Provider | COOPER |
| First Name Of The Provider | WENDY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | N14W23900 STONE RIDGE DR |
| Street Address 2 Of The Provider | PROHEALTH CARE MEDICAL ASSOCIATES INC. |
| City Of The Provider | WAUKESHA |
| Zip Code Of The Provider | 531881135 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 518 |
| Number Of Medicare Beneficiaries | 93 |
| Total Submitted Charge Amount | 59648 |
| Total Medicare Allowed Amount | 27818.41 |
| Total Medicare Payment Amount | 20319.84 |
| Total Medicare Standardized Payment Amount | 21401.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 60 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 2591 |
| Total Drug Medicare AllowedAmount | 1776.24 |
| Total Drug Medicare PaymentAmount | 1712.68 |
| Total Drug Medicare Standardized Payment Amount | 1712.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 458 |
| Number Of Medicare Beneficiaries With Medical Services | 93 |
| Total Medical Submitted Charge Amount | 57057 |
| Total Medical Medicare Allowed Amount | 26042.17 |
| Total Medical Medicare Payment Amount | 18607.16 |
| Total Medical Medicare Standardized Payment Amount | 19689.02 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9953 |