| National Provider Identifier [NPI]: | 1558520866 |
| Last Name Of The Provider | EWAN |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1630 N CHIPPEWA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | RHINELANDER |
| Zip Code Of The Provider | 54501 |
| 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 | 142 |
| Number Of Services | 9329 |
| Number Of Medicare Beneficiaries | 1347 |
| Total Submitted Charge Amount | 772073 |
| Total Medicare Allowed Amount | 149668.79 |
| Total Medicare Payment Amount | 127924.22 |
| Total Medicare Standardized Payment Amount | 130608.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 508 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 6058 |
| Total Drug Medicare AllowedAmount | 2873.31 |
| Total Drug Medicare PaymentAmount | 2509.14 |
| Total Drug Medicare Standardized Payment Amount | 2509.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 8821 |
| Number Of Medicare Beneficiaries With Medical Services | 1346 |
| Total Medical Submitted Charge Amount | 766015 |
| Total Medical Medicare Allowed Amount | 146795.48 |
| Total Medical Medicare Payment Amount | 125415.08 |
| Total Medical Medicare Standardized Payment Amount | 128099.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 640 |
| Number Of Beneficiaries Age 75 to 84 | 405 |
| Number Of Beneficiaries Age Greater 84 | 164 |
| Number Of Female Beneficiaries | 708 |
| Number Of Male Beneficiaries | 639 |
| Number Of Non Hispanic White Beneficiaries | 1304 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1154 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 193 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.0267 |