| National Provider Identifier [NPI]: | 1871544692 |
| Last Name Of The Provider | GREEN |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 840 N 87TH ST |
| Street Address 2 Of The Provider | SARGEANT HEALTH CENTER |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532263586 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 592 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 135413.23 |
| Total Medicare Allowed Amount | 43980.58 |
| Total Medicare Payment Amount | 31262.23 |
| Total Medicare Standardized Payment Amount | 33205.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 2957.22 |
| Total Drug Medicare AllowedAmount | 2156.38 |
| Total Drug Medicare PaymentAmount | 2093.38 |
| Total Drug Medicare Standardized Payment Amount | 2093.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 525 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 132456.01 |
| Total Medical Medicare Allowed Amount | 41824.2 |
| Total Medical Medicare Payment Amount | 29168.85 |
| Total Medical Medicare Standardized Payment Amount | 31112.55 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | 44 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | 117 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 127 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9876 |