| National Provider Identifier [NPI]: | 1184881898 |
| Last Name Of The Provider | POTACZEK |
| First Name Of The Provider | MELANIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 114 TIMBERLANE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOONER |
| Zip Code Of The Provider | 548019687 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 1766 |
| Number Of Medicare Beneficiaries | 435 |
| Total Submitted Charge Amount | 340363 |
| Total Medicare Allowed Amount | 94279.24 |
| Total Medicare Payment Amount | 63534.77 |
| Total Medicare Standardized Payment Amount | 76554.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 85 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 28060 |
| Total Drug Medicare AllowedAmount | 14613.93 |
| Total Drug Medicare PaymentAmount | 11424.72 |
| Total Drug Medicare Standardized Payment Amount | 11424.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 1681 |
| Number Of Medicare Beneficiaries With Medical Services | 435 |
| Total Medical Submitted Charge Amount | 312303 |
| Total Medical Medicare Allowed Amount | 79665.31 |
| Total Medical Medicare Payment Amount | 52110.05 |
| Total Medical Medicare Standardized Payment Amount | 65129.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 217 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 255 |
| Number Of Male Beneficiaries | 180 |
| Number Of Non Hispanic White Beneficiaries | 421 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 382 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7609 |