Wisconsin - Claims Paid - FPW - 2007-2010

Medicaid Expenditures for the Family Planning Only Benefit Plan Claims Paid in SFY 2007 through SFY
2010
Source: Bus Obj Claims Analysis Universe Run Date: October 17, 2011
Billing Provider County
Adams
Ashland
Billing Provider Type Mental Health and Substance Abuse Services ADAMS CO HEALTH & HUMANSVCS Independent Lab MOUNDVIEW MEMORIAL HOSPITAL Rural Health Clinic Hospital MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC Physician Group Pharmacy PAMIDA PHARMACY 373 Pharmacy PHILLIPS ROCHE A CRI PHARMAC Therapy Group RIVERVIEW REHABILITATION Physician Group ROCHE A CRI CLINIC SC Rural Health Clinic Physician Group ASHLAND PATHOLOGY SERVICES Federally Qualified Health Clinic (FQHC) BAD RIVER HEALTH SERVICES Physician Group Physician Group CHEQUAMEGON CLINIC Physician DENNIS SULLIVAN, MD Family Planning Clinic DOUGLAS CO COMMUNITY HLTH Physician Group ENT PROFESSIONAL ASSOCSC ESSENTIA HEALTH ASHLAND CLINIC Physician Group Physician Group ESSENTIA HEALTH ASHLAND ORTHOPAEDICS CLINIC Physician Group FALL GENERALSURGERY LLC Pharmacy HUHN RX DRUGINC Physician JAMES A HAMP, MD Physician Group KENNETH N KRUTSCH MD SC Physician KENNETH N KRUTSCH, MD Physician KEVIN J MCCLELLAND, MD Physician Group MAINSTREET CLINIC SC Page 1 of 114
Billing Provider Name
SFY 2007
SFY 2008
SFY 2009
SFY 2010
Total
$1,540 $2,220 $3,197 $1,481
$1,199 $5,823 $3,868 $1,464
$22 $399 $1,595 $15,378 $3,225 $1,305 $30 $339 $490 $565
$68 $138 $3,582 $27,433 $572 $1,316 $1,656
$2,442 $709 $125 $105 $3,735 $12
$2,270 $472 $137 $217 $2,201 $58,830
$118 $119 $795 $23 $3,821 $361,201 $61 $6,668 $61 $184 $5,811 $78
$91 $538 $7,916 $50,854 $572 $11,606 $5,906 $30 $339 $5,319 $1,866 $1,058 $439 $13,184 $12 $666,598 $61 $20,105 $61 $228 $22,945 $30 $78 $41 $108 $9,260
$94 $3,427 $246,566 $3,814 $44 $4,676 $30
$4,660
$4,963
$6,912
$5,546
$41 $1,534 $1,897 $1,895 $108 $3,934
Medicaid Expenditures for the Family Planning Only Benefit Plan Claims Paid in SFY 2007 through SFY 2010
Billing Provider Name MARJORIE A LINDEMANN, NP MEMORIAL MEDICAL CENTER
Barron
Billing Provider Type Nurse Practitioner Independent Lab Physician Group Hospital MEMORIAL MEDICAL CENTER INC NORTHERN WATERS OPHTHALMOLOG Physician Group Pharmacy PAMIDA PHARMACY #390 Pharmacy THE MEDICINE SHOPPE Physician THOMAS A GUFFY, MD Pharmacy WAL MART PHARMACY 101672 Pharmacy WALGREENS #10758 Family Planning Clinic BARRON COUNTY DHHS Physician Group BRANHAM HEALY ORTHOPEDIC Physician Group CUMBERLAND CLINIC CUMBERLAND MEMORIAL HOSPITAL Hospital Independent Lab Physician Group DIAGNOSTIC RADIOLOGY ASSOC Pharmacy ECONOFOODS PHARMACY #325 Transportation HANDI LIFT INC Pharmacy JAMES PHARMACY Pharmacy JAMES PHARMACY LTD Pharmacy K MART PHARMACY #9704 Anesthetist LAKEVIEW MEDICAL CENTER Hospital LAKEVIEW MEDICAL CTR LUTHER MIDELFORT NORTHLAND -MHSAnesthetist Independent Lab MARSHFIELD CLINIC CUMBERLAND Independent Lab MARSHFIELD CLINIC LAKE Independent Lab MARSHFIELD CLINIC LAKESWOODS FAMILY CENTER Pharmacy MARSHFIELD CLINIC PHARMACY Independent Lab MARSHFIELD CLINIC RICE LAKE CENTER Page 2 of 114
SFY 2007 $123 $389 $597 $1,605 $6,547 $4,028 $77,760 $1,915
SFY 2008 $582 $726 $2,131 $7,065 $4,183 $109,880 $2,106
SFY 2009 $432 $126 $8,665 $2,181 $8,094 $5,721 $71,117 $3,136 $641 $24 $156 $457 $585 $1,661 $1,367 $5,954 $253 $11
SFY 2010 $421 $1,331 $28,630 $217 $2,896 $6,317 $52 $7,323 $5,603 $33,685 $116 $2,288 $685 $58 $121 $1,363 $1,246 $3,014 $2,445 $10,042 $43 $22 $7,377 $51
$991 $690 $3,550 $3,256 $129 $532
$35 $1,783 $392 $2,513 $943 $1,969
$10 $2,839 $831
$21 $2,630 $675
$3,259 $808
Total $123 $1,824 $1,457 $38,618 $217 $8,813 $28,024 $52 $21,256 $5,603 $292,441 $116 $9,445 $1,326 $83 $312 $4,595 $392 $5,034 $9,168 $9,038 $129 $16,528 $253 $54 $22 $31 $16,106 $2,366
Bayfield
Brown
Billing Provider Name Billing Provider Type SFY 2007 Physician Group MAYO CLINIC HEALTH SYSTEM NORTHLAND BARRON CLINIC $2,362 Hospital MAYO CLINIC HEALTH SYSTEM NORTHLAND INC $211 Pharmacy MEDICATIONS PLUS PHARMACY $1,246 Pharmacy OHDE HEALTH MART PHARMACY $3,546 Pharmacy OSTERBAUER DRUG LTD $1,305 Pharmacy SCHNEIDER DRUG $577 Pharmacy SHOPKO PHARMACY #2132 $7,890 Pharmacy THE APOTHECARY $3,417 Physician Group TURTLE LAKE MEDICAL ASSOC SC $30 Physician Group TURTLE LAKE MEDICAL CLINIC Pharmacy WALGREENS #11860 Pharmacy WAL-MART PHARMACY 10-1446 $11,957 Pharmacy LANGFORD PHARMACY $1,058 Federally Qualified Health Clinic (FQHC) RED CLIFF COMMUNITY HEALTH $1,556 Medical Equipment Vendor $25 Physician STEPHEN R KREUSER, MD Federally Qualified Health Clinic (FQHC) THE LAKES COMMUNITY HEALTH Physician ALLAHYAR JAZAYERI, MD Hospital AURORA BAYCARE MEDICALCTR $2,204 Physician Group AURORA HEALTH CENTER $14,530 Physician Group AURORA MEDICAL GROUP $1,119 Physician Group AURORA MEDICAL GROUP INC $1,358 Pharmacy AURORA PHARMACY INC $1,608 Physician Group BAYCARE CLINIC LLP $235 BELLIN ANESTHESIA ASSOCIATES SC Physician Group Independent Lab BELLIN HEALTH $10,010 Page 3 of 114
SFY 2008 $1,418 $869 $4,755 $643 $1,180 $7,582 $2,622
SFY 2009 $2,734 $1,449 $237 $4,140 $676 $1,340 $7,397 $3,954
SFY 2010 $9,708 $2,681 $1,968 $10,055 $1,595 $2,497 $12,417 $4,888 $159 $11,393 $30,172 $2,308 $6,966
$16,396 $643 $1,914 $34 $72
$3,699 $16,805 $2,505 $2,353
Total $16,222 $4,341 $4,320 $22,495 $4,218 $5,594 $35,286 $14,881 $30 $159 $15,092 $75,331 $6,513 $12,790 $59 $254 $1,660 $1,824 $14,783 $43,768 $8,897 $13,107 $9,004 $2,296 $233 $36,607
$182 $145 $439 $1,567 $11,639 $1,676 $1,768 $2,190 $195 $8,426 $1,515 $22 $9,296 $7,604 $4,684 $9,247 $2,744 $1,528 $233 $10,666
$1,362 $1,717 $9,996 $1,417 $733 $2,463 $338 $7,506
Billing Provider Name Billing Provider Type Physician Group BELLIN HEALTH FASTCARE BELLIN HEALTH FASTCARE GREEN BAYPhysician Group Pharmacy BELLIN HEALTH PHARMACY Anesthetist BELLIN MEMORIAL HOSPITAL Hospital Physician CARDIOLOGY ASSOCIATES OF GREEN BAY, LTD Group Physician Group CENTER FOR ASTHMA AND ALLERG Physician CLARK W STEVENS MD, MD Physician Group CLINICA HISPANA COPPS FOOD CENTER PHARMACY #8107Pharmacy COPPS FOOD CENTER PHARMACY #8111Pharmacy COPPS FOOD CENTER PHARMACY #8186Pharmacy Pharmacy CUB PHARMACY Pharmacy CVS PHARMACY#08535 Pharmacy CVS PHARMACY#08541 Pharmacy CVS PHARMACY#08542 Physician DANAE C STEELE MD, MD Physician DANIEL J LINEHAN, MD Physician DERMATOLOGY ASSOCIATES OF WISCONSIN SC Group Physician Group DERMATOLOGY ASSOCIATESOF WI Physician Group DOUSMAN CLINIC SC Physician EDWARD G VOGEL, MD Physician Group ENDOCRINOLOGYASSOCIATESOFGREEN BAY, SC Physician Group FMC ASHWAUBENON Physician PEDIATRICS FMC ASHWAUBENON INTERNAL MEDICINE AND Group Physician Group FMC BELLEVUE Physician Group FMC DE PERE Physician Group FMC DENMARK Physician Group FMC EAST DEPERE Page 4 of 114
SFY 2007 $59 $20 $1,020 $343 $362 $30 $2,719
SFY 2008 $22 $1,368 $494 $60 $1,698 $57
SFY 2009 $216 $1,270 $10,303
SFY 2010 $58 $145 $1,266 $19,788 $55
$1,002 $58 $34 $87 $301 $256 $2,682 $3,473 $2,289
$1,229 $959 $1,903 $2,476 $1,156 $60
$1,131 $1,213 $4,030 $3,399 $3,280
$681 $2,061 $3,454 $1,556 $160 $92
$139 $164 $60 $766 $60 $395 $90
$120
$312
$299 $55 $231
$1,536 $47 $349 $36 $87
$1,136 $384 $581 $30 $76
$2,459 $204 $2,658 $993 $229 $251
Total $116 $402 $4,925 $343 $30,947 $115 $30 $5,419 $114 $87 $335 $256 $3,041 $6,915 $12,861 $9,720 $4,597 $60 $391 $55 $803 $164 $60 $5,897 $311 $3,043 $2,318 $296 $505
Billing Provider Name FMC HOWARD FMC LUXEMBURG FMC PEDIATRICS EAST FMC PULASKI FMC WEBSTER AVE FMC WRIGHTSTOWN GBR SHEBOYGAN LLC GREEN BAY ALLERGY ASTHMA AND GREEN BAY ONCOLOGY LTD GREEN BAY ORTHOPEDICS LTD GREEN BAY RADIOLOGY SC GREEN BAY SURGICAL CENTER HERBERT F SANDMIRE, MD HERBERT S COUSSONS, MD HOSPITAL DIAGNOSTIC SERVICES JOHN B FRAZIER, DDS JOHN M HALE, MD JOSEPH R DOBSON, DO JUDITH A HARDING, NP K MART PHARMACY 4219 KATHLEEN G STEWARD, NP KIMBERLY M WILLIAMS, NP KRIDER PHARMACY & HOMEHEALTH LINDA S HAEN, NP LOREN P SCHOLL, NP LOUANN WEIX, CRNA MARY A SAUVEY, MD MEGAN E TEMP, MD
Billing Provider Type Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Ambulatory Surgical Center (ASC) Physician Physician Physician Group Dentist Physician Physician Nurse Practitioner Pharmacy Nurse Practitioner Nurse Practitioner Pharmacy Nurse Practitioner Nurse Practitioner Anesthetist Physician Physician Page 5 of 114
SFY 2007 $174 $66 $86 $1,608
SFY 2008 $250 $26 $73 $216 $1,176 $57 $98
SFY 2009 $271 $57 $230 $926 $30
SFY 2010 $2,473 $77 $239 $273 $1,074 $58 $37 $48
$43 $25 $207 $204 $386 $73 $930 $217 $182 $30 $83 $62 $361
Total $3,168 $225 $312 $804 $4,783 $145 $37 $98 $48 $43 $447 $1,137 $421 $873 $30 $156 $26 $197 $58 $650 $58 $163 $695 $43 $43 $174 $57 $1,244
$304
$133 $163 $141
$142 $58 $164 $58 $115 $43 $174 $57 $183 $68 $43
$26 $55 $354
$371
$558
$503
Billing Provider Name MICHAEL BROCKMAN, MD MICHAEL C O TOOLE, MD MICHAEL J SMULLEN, MD NARAYAN AMARNANI MD SC NEUROLOGY CONSULTANTS OF
Billing Provider Type Physician Physician Physician Physician Group Physician Group Federally Qualified Health Clinic (FQHC) NEW COMMUNITY CLINIC Physician Group NEW ENT SC Physician Group NEW MOMS SC Physician Group NEW SURGICAL ASSOCIATES SC Physician Group OB GYN ASSOCIATES LTD Physician Group ORTHOPEDICS AND SPORTS MEDICINE SPECIALISTS OF GRE Pharmacy OSCO DRUG #5036 Pharmacy OSCO DRUG #5054 Pharmacy OSCO DRUG #5055 Nurse Practitioner PAMELA L NILES, NP PATHOLOGY CONSULTANTS OF GREEN Physician Group BAY, SC Physician Group PATHOLOGY PHYSICIANS LTD Physician PERI L ALDRICH, MD Physician PHILIP L GOOLSBY, MD Family Planning Clinic PLANNED PARENTHOOD OF WI Independent Lab PREVEA CLINIC Physician Group Mental Health and Substance Abuse Services PREVEA CLINICBEHAVIORALCARE Independent Lab PREVEA HEALTH Physician Group Independent Lab PREVEA REGIONAL SERVICES Page 6 of 114
SFY 2007 $735 $19
SFY 2008 $236
SFY 2009 $22 $1,034 $22 $30
SFY 2010
Total $22 $2,005 $111 $240 $296 $415 $174 $2,658 $66 $13,191 $185 $542 $2,681 $906 $242 $18,285 $403 $80 $58 $607,251 $13,834 $36,218
$111 $199 $266 $385 $174
$30 $1,855 $803 $73 $30 $542 $2,681 $906 $242 $4,065 $157 $3,416 $30
$66 $9,702 $125
$4,074 $245 $80 $156,989 $3,737 $9,792
$4,316
$5,830
$44,685 $3,985 $13,757
$58 $179,784 $3,850 $6,931
$225,793 $2,261 $5,738
$2,790
$43 $3,350 $11,036
$11
$2,833 $3,350 $11,036 $11
Billing Provider Name PREVEA REGIONAL SERVICES INC PULASKI PHARMACY RADIOLOGY CHARTERED RANDI M BURNHAM, NP ROBERT A CAVANAUGH, MD ROBERT K DEMOTT MD, MD SAM'S PHARMACY 10-8149 SHOPKO EXPRESS #501 SHOPKO EXPRESS #502 SHOPKO EXPRESS #506 SHOPKO PHARMACY #2001 SHOPKO PHARMACY #2002 SHOPKO PHARMACY #2005 SHOPKO PHARMACY #2177 SHOPKO PHARMACY 2004 ST MARYS HOSP MED CENTER ST MARYS HOSPITAL MEDICAL ST VINCENT HOSPITAL
Billing Provider Type Physician Group Pharmacy Physician Group Nurse Practitioner Physician Physician Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Hospital Independent Lab Hospital Independent Lab Physician Group ST VINCENT HOSPITAL CLINICS Pharmacy STOWE DRUG STORE Pharmacy STREUS PHARMACY INC Physician Group SURGERY SPECIALISTS OFGREEN Pharmacy TARGET STORE T-1247 PHARMACY Pharmacy TARGET STORE T-1483 PHARMACY Physician Group UROLOGY ASSOCIATES OF GREEN BAY,SC Pharmacy WALGREENS #03088 Pharmacy WALGREENS #03115 Pharmacy WALGREENS #03133 Page 7 of 114
SFY 2007 $1,137 $60 $1,541 $1,286 $70 $2,006 $2,367 $1,472 $3,028 $2,599 $5,166 $150 $2,852 $4,055 $155 $674 $2,178 $1,704 $14,321 $5,688 $8,899
SFY 2008 $935
SFY 2009 $95 $334 $25 $242 $1,163 $49 $708 $2,050 $855 $1,905 $2,255 $911 $1,446 $3,638 $21,010 $7,309 $9,162 $398 $135 $749 $1,871 $2,407 $8,070 $3,243 $6,477
SFY 2010 $132 $338 $227
$866 $899 $70 $1,312 $2,332 $1,176 $2,446 $811 $4,865 $589 $5,900 $678 $1,112 $549 $55 $833 $2,006 $1,906 $8,934 $6,198 $9,703
$82 $1,211 $2,799 $693 $2,000 $5,293 $1,663 $2,221 $6,071 $10,854 $4,691 $18,800 $2,529 $74 $1,700 $108 $864 $4,042 $48 $10,566 $5,461 $4,980
Total $227 $2,744 $252 $60 $2,649 $3,348 $270 $5,237 $9,548 $1,548 $6,551 $13,021 $5,983 $3,667 $19,741 $32,603 $20,752 $28,640 $8,094 $623 $344 $3,956 $108 $6,920 $10,059 $48 $41,891 $20,590 $30,059
Buffalo
Burnett
Billing Provider Name WALGREENS #03253 WALGREENS #11339 WALGREENS #11576 WALGREENS 05746 WALGREENS 06569 WALGREENS 10235 WAL-MART PHARMACY 10-1453 WAL-MART PHARMACY 10-1908 WAL-MART PHARMACY 10-5090 WISCONSIN OCULOPLASTICSLTD WOMENS HEALTH CARE OB GYN SC WOMENS SPECIALTY CARE YOON W CHUN MD, MD CITY DRUG STORE INC KASSEL CITY DRUG LLC MONDOVI HEALTH MART PHARMACY BURNETT MEDICAL CENTER BURNETT MEDICAL CENTERCLINIC BURNETT MEDICAL CENTERINC
Calumet
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Group Physician Group Physician Group Physician Pharmacy Pharmacy Pharmacy Physician Group Rural Health Clinic Hospital Independent Lab Family Planning Clinic COUNTY OF BURNETT Physician Group INGALLS FAMILY MEDICINECLINI Pharmacy OLSEN & SON DRUG Pharmacy WOOD RIVER PHARMACY Pharmacy YELLOW RIVER PHARMACY Pharmacy YELLOW RIVERPHARMACY INC Pharmacy APOTHECARY SHOP APPLETON CARDIOLOGY THEDACARE Physician Group Hospital APPLETON MEDICAL CENTER Page 8 of 114
SFY 2007 $6,678
$3,775 $2,873 $1,799 $9,176 $6,907 $2,321 $1,777 $4,588 $396 $1,040 $26 $3,312 $496 $163 $5,544 $2,366 $5,858 $6,243 $3,745 $121 $94 $1,227
SFY 2008 $8,514 $776 $538 $3,739 $2,756 $2,473 $9,324 $4,369 $1,820 $2,218 $3,275
SFY 2009 $8,550 $7,481 $3,098 $5,545 $3,109 $2,705 $6,877 $6,350 $2,430 $1,223 $939 $126 $1,790 $1,373 $2,702 $437 $2,088 $1,591 $3,958 $4,369 $3,114
SFY 2010 $8,347 $7,750 $4,833 $5,128 $5,147 $4,572 $15,760 $7,522 $5,058 $55 $904 $2,297
$1,070 $1,824 $1,314 $398 $3,285 $2,285 $3,669 $6,264 $1,515 $2,749 $119 $3,360
$496 $1,307 $61 $1,758 $5,941 $309 $1,177 $2,733 $2,280 $4,099 $3,945
$21,535
$78 $28,356
Total $32,088 $16,007 $8,469 $18,187 $13,885 $11,548 $41,136 $25,148 $11,628 $55 $6,122 $2,297 $8,801 $396 $622 $5,207 $87 $8,267 $10,453 $1,307 $12,094 $8,976 $15,765 $20,975 $8,574 $6,494 $240 $172 $54,478
Billing Provider Name AURORA PHARMACY INC CALUMET MEDICAL CENTER
Chippewa
Billing Provider Type Pharmacy Hospital Physician Group Independent Lab CALUMET MEDICAL CENTER INC COPPS FOOD CENTER PHARMACY #8123Pharmacy Pharmacy CVS PHARMACY #05186 Physician Group FMC BRILLION Nurse Practitioner FRANCES E NELSON, NP Physician Group IHC CALUMET EMERGENCY PHYSICIANS LLC Pharmacy MORTON PHARMACY Rural Health Clinic NELSON FAMILYCLINIC LLC Pharmacy OCONNOR PHARMACY Physician RANDY T THEILER, MD Physician Group THEDACARE PHYSICIANS HILBERT Pharmacy WALGREENS #13065 Pharmacy WAL-MART PHARMACY 10-2509 Pharmacy WAL-MART PHARMACY 10-2958 Physician Group CADOTT MEDICAL CENTER SC Pharmacy CADOTT MILLER PHARMACY Pharmacy CHIPPEWA CLINIC PHARMACY Physician CLIFFORD T BOWE, MD Pharmacy CORNELL PHARMACY Pharmacy CORNELL PHARMACY INC Pharmacy EDS HEALTH MART PHARMACY Pharmacy EDS PHARMACY Physician Group FAMILY HEALTH ASSOCIATES Physician Group FAMILY HEALTH MEDICAL Pharmacy GROUP HEALTHCHIPPEWA PHARMA Pharmacy K MART PHARMACY 3735 Page 9 of 114
SFY 2007 $221
SFY 2008 $196
SFY 2009 $190 $1,615 $46
SFY 2010 $506 $1,577 $289 $70 $118 $2,679 $3,979 $1,471 $397 $2,479 $167 $3,963 $11,224 $314 $1,286 $657 $2,372 $3,094 $43 $3,002 $902 $1,005
$57 $12,900 $30 $342 $203 $57
$27,698 $355 $837 $65
$332 $39,140 $276 $943
$3,007 $4,236 $205 $1,282
$4,300 $6,083 $249 $947
$3,743 $5,259 $90 $324 $22 $147 $1,476 $311
$945 $372 $351 $1,333 $2,273 $1,920
$1,336 $705
$1,569 $2,180 $1,246
$1,177 $4,033 $969
Total $916 $3,388 $289 $116 $118 $2,679 $388 $83,718 $30 $2,102 $1,179 $1,609 $57 $2,479 $167 $15,012 $26,802 $544 $2,867 $1,286 $679 $2,427 $3,848 $4,482 $351 $43 $7,082 $9,388 $5,139
Clark
Billing Provider Name Billing Provider Type SFY 2007 Pharmacy KONSELLA DRUG INC $781 KONSELLA HEALTH MART PHARMAC Pharmacy Independent Lab MARSHFIELD CLINIC BLOOMER CENTER Independent MARSHFIELD CLINIC CHIPPEWA FALLS CTR LAB Lab Physician Group MARSHFIELD CLINIC LAKE HALLIE CENTER Federally Qualified Health Clinic (FQHC) MARSHFIELD CLINIC PHARMACY $5,751 Physician Group MAYO CLINIC HEALTH SYSTEM CHIPPEWA VALLEY BLOOMER $129 Hospital MAYO CLINIC HEALTH SYSTEM CHIPPEWA VALLEY INC Pharmacy MEDICINE SHOPPE $631 Pharmacy OLV PHARMACY $1,836 Hospital OUR LADY OF VICTORY HOSPITAL $305 Physician Group $30 Physician PAUL M IPPEL, MD $131 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic $567,924 Pharmacy SHOPKO PHARMACY #2037 $2,325 Hospital ST JOSEPHS HOSPITAL $1,808 Independent Lab $45 Pharmacy ST JOSEPHS HOSPITAL PHARMACY Pharmacy WALGREENS 07966 $6,055 Pharmacy WAL-MART PHARMACY 10-5373 $3,831 Family Planning Clinic CLARK CO FAMILY PLANNING $56,820 Independent MARSHFIELD CLINIC COLBY ABBO CENTER LAB Lab Physician Group MEMORIAL HOSPITAL INC $675 Hospital MEMORIAL HOSPITAL INC #171 Rural Health Clinic MEMORIAL MEDCTR GREENWOOD $746 Rural Health Clinic MEMORIAL MEDICAL CENTER $1,592 Independent Lab MEMORIAL MEDICAL CENTER LABO $183 Rural Health Clinic MEMORIAL MEDICAL CTR $3,053 Page 10 of 114
SFY 2008 $21
SFY 2009 $736 $11 $139 $14
SFY 2010 $610
$1,280 $7,759 $4,253 $1,631 $4,937 $1,364 $3,957 $375 $29,034 $2,477 $42,525 $1,025 $11,083 $12,244 $71,741
Total $802 $1,346 $11 $139 $1,294 $26,868 $5,646 $1,631 $7,495 $5,552 $10,366 $471 $131 $1,329,830 $11,476 $86,310 $1,982 $51 $30,508 $28,349 $256,113 $11 $811 $14,880 $4,018 $8,003 $1,266 $10,758
$5,319 $861 $681 $1,086 $1,789 $66 $412,735 $2,593 $5,385 $363 $51 $7,418 $4,739 $73,204 $136 $1,584 $656 $1,947 $198 $2,320
$8,040 $402 $1,246 $1,266 $4,314
$320,137 $4,082 $36,592 $548 $5,951 $7,535 $54,348 $11 $5,389 $1,120 $2,186 $211 $1,663
$7,907 $1,496 $2,278 $674 $3,722
Billing Provider Name OLV PHARMACY OUR LADY OF VICTORY HOSPITAL
Columbia
Billing Provider Type Pharmacy Hospital Physician Group Pharmacy OWEN WITHEE PHARMACY Pharmacy PAMIDA PHARMACY #324 Pharmacy SNITEMAN INC Rural Health Clinic VICTORY MEDICAL GROUP Rural Health Clinic VICTORY MEDICAL GROUP OWEN Physician BRUCE A KRAUS M.D., MD Hospital COLUMBUS COMMUNITY HOSP INC Independent Lab COLUMBUS COMMUNITY HOSPITAL Physician Group Hospital DIVINE SAVIOR HEALTHCARE Independent Lab DIVINE SAVIOR HEALTHCARE INC Physician Group Dentist GENE R SORENSEN, DDS Pharmacy HARRIS PHARMACY INC Physician JOHN E WALZ, MD Pharmacy K MART PHARMACY 3768 Physician Group LODI MEDICAL CLINIC PARDEEVILLE HOMETOWN PHARMACYPharmacy Family Planning Clinic PLANNED PARENTHOOD OF WI Physician Group PORTAGE RADIOLOGY SC Pharmacy POYNETTE HOMETOWN PHARMACY RANDOLPH HOMETOWN PHARMACY Pharmacy Pharmacy RHYME DRUG Pharmacy RIO HOMETOWN PHARMACY Physician SAMUEL POSER, MD Pharmacy SHARROW DRUGS INC Page 11 of 114
SFY 2007
SFY 2008
SFY 2009
$3,133 $2,303 $4,234 $514 $378 $3,161 $365 $537 $278 $105 $2,925 $310 $841 $787
$2,895 $1,891 $4,891 $299 $183 $7,762 $139 $649 $1,518 $234 $3,139 $310 $828 $22 $1,928 $91 $12 $460 $960 $30 $43 $867
$3,235 $3,337 $3,182 $291 $103 $20,743 $154 $688 $6,746 $445 $4,595 $1,447 $2,963 $264 $680 $123,833 $440 $212 $147 $58 $919
SFY 2010 $900 $5,283 $26 $3,358 $3,158 $3,900 $1,106 $1,112 $2,093 $11,418 $235 $450 $13,885 $448 $3,862 $706 $22 $2,775 $427 $465 $53,276 $57 $136 $333 $136 $95 $420
$426 $28 $160 $73 $2,104
Total $900 $5,283 $26 $12,621 $10,689 $16,207 $2,210 $1,775 $2,093 $43,084 $893 $2,324 $22,426 $1,233 $14,522 $620 $3,822 $44 $8,454 $691 $1,236 $177,109 $70 $1,036 $1,932 $58 $442 $268 $4,309
Crawford
Dane
Billing Provider Name Billing Provider Type Physician STEPHEN C PAULK, MD Physician STEWART F TAYLOR JR, MD Pharmacy TRAVEL MART PHARMACY Pharmacy VILLAGE DRUG Pharmacy WALGREENS #10396 Pharmacy WALGREENS 07732 Pharmacy WAL-MART PHARMACY 10-1799 Pharmacy WILZ DRUG INC Physician Group GREAT RIVER COMMUNITY MEDICAL CLINIC Physician Group GUNDERSEN CLINIC LTD Pharmacy HARTIG DRUG CO INC Pharmacy HIMRICHS SNYDER DRUGS Rural Health Clinic KICKAPOO VALLEY MEDICAL Physician Group KICKAPOO VALLEY MEDICALCLINI Hospital PRAIRIE DU CHIEN MEMORIAL P PRAIRIE DU CHIEN MEMORIAL HOSPITALhysician Group Pharmacy PRAIRIE PHARMACY INC Pharmacy PRAIRIE PRESCRIPTION Anesthetist RONALD F FALCH, APNP Pharmacy SOLAR TOWN PHARMACY VMH Pharmacy WALGREENS #10682 Pharmacy WAL-MART PHARMACY 10-0882 Federally Qualified Health Clinic (FQHC) ACCESS COMMUNITY HEALTH CENTERS Pharmacy Physician Group ASSOCIATED PATHOLOGISTS Physician Group ASSOCIATED PHYSICIANS LLP Nurse Practitioner ASZANI S KUNKLER, NP BELLEVILLE HOMETOWN PHARMACY Pharmacy Page 12 of 114
SFY 2007 $22 $22 $1,931 $1,351 $352 $4,409 $2,808 $1,157 $1,532 $1,458 $290 $78
SFY 2008 $55 $1,032 $323 $1,612 $4,301 $6,282 $848 $3,011 $1,425 $370 $11 $1,499 $14 $441 $158 $441 $4,862 $2,097 $5,859 $714 $667 $30 $327
SFY 2009
SFY 2010
Total $77 $22 $7,902 $1,675 $10,220 $19,351 $21,019 $3,327 $497 $6,396 $5,791 $290 $1,806 $96 $5,524 $110 $1,512 $51 $158 $1,658 $10,026 $8,117 $38,796 $603 $3,406 $2,854 $151 $1,679
$1,768 $2,670 $3,532 $6,952 $817 $1,853 $687 $496 $11 $2,178 $275
$3,171 $5,585 $7,109 $4,976 $506 $497 $2,222 $862 $75 $1,846 $96 $524
$272 $51 $120 $1,070 $3,045 $2,285 $630 $297 $121 $764
$102 $1,705 $2,148 $8,421 $397 $860 $154
$995 $2,389 $827 $22,231 $603 $1,665 $1,029 $434
Billing Provider Name Billing Provider Type SFY 2007 Pharmacy BERGMANN PHARMACY $130 Pharmacy BERGMANNS PHARMACY INC $1,168 Pharmacy BERGMANNS PHARMACY INC $2,122 Independent Lab BOARD OF REGENTS UNIV OF WI $699,538 Physician Group BONE & JOINTSURGERY ASSOCIA Pharmacy COMMUNITY PHARMACY $7,446 COPPS FOOD CENTER PHARMACY #8102Pharmacy COPPS FOOD CENTER PHARMACY #8178Pharmacy $191 COPPS FOOD CENTER PHARMACY #8180Pharmacy Pharmacy CROSS PLAINSPHARMACY LLC $497 Pharmacy CUB PHARMACY $1,094 Pharmacy CVS PHARMACY #05584 Independent Lab DANE CO CYTOLOGY CENTERINC $10,273 Physician DAVID L OLIVE, MD Ambulatory Surgical Center (ASC) DAVIS DUEHR SURGERY CENTER Anesthetist DEAN HEALTH SYSTEMS INC Physician Group $50,616 Mental Health and Substance Abuse DEAN MEDICAL CENTER DEPARTMENT Services OF PSYCHIATRY FISH Pharmacy DEAN PHARMACY $2,292 Pharmacy DEFOREST HOMETOWN PHARMACY $846 Pharmacy DOOR CREEK PHARMACY $729 Pharmacy DOOR CREEK PHARMACY DEERFIEL $304 Physician Group FORT HEALTHCARE INC $137 Pharmacy GHC EAST CLINIC PHARMACY Pharmacy GHC HATCHERYHILL PHARMACY Pharmacy GHC PHARMACYCAPITOL Page 13 of 114
SFY 2008
SFY 2009
SFY 2010
$453 $1,697,002 $13,669 $322 $24 $206 $39 $653 $10,811 $20
$512 $1,673,881 $91 $6,106 $88 $534
$1,861,830 $55 $13,249 $218 $789 $25 $148 $1,823 $20,244
$1,239 $11,534
Total $130 $1,168 $3,087 $5,932,251 $146 $40,470 $629 $1,538 $206 $560 $3,135 $1,823 $52,863 $20 $724 $631 $267,519
$268 $55,438
$724 $107 $58,358
$255 $103,107
$3,687 $806 $107 $681 $89 $84
$22 $2,401 $1,137 $613 $382 $48 $96 $349 $327
$66 $4,823 $1,739 $612 $365 $234 $903 $605 $1,728
$88 $13,204 $4,528 $2,060 $1,732 $419 $1,087 $954 $2,139
Billing Provider Name Billing Provider Type Pharmacy GHC PHARMACYSAUK TRAILS Pharmacy GHC SCW MAILPHARMACY Physician Group GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI Pharmacy HARRIS PHARMACY Pharmacy HY VEE PHARMACY 1391 Physician JOHN NOON, MD Physician KENNETH H YUSKA Physician Group MADISON ANESTHESIOLOGY CONSULTANTS MADISON AREA RENAL SPECIALISTS Physician Group Nurse Practitioner MADISON BIRTH CENTER Physician Group MADISON RADIOLOGISTS SC Pharmacy MALLATT PHARMACY MCFARLAND HOMETOWN PHARMACY Pharmacy Pharmacy MCGLYNN PHARMACY INC Pharmacy MEDICINE SHOPPE 0605 LTD Hospital MERITER HOSPITAL INC Physician Group Independent Lab MERITER LABORATORIES Physician Group MERITER MEDICAL GROUP INC Physician MICHAEL H MCDONALD, MD Pharmacy MT HOREB PHARMACY Pharmacy NEUHAUSER PHARMACY Physician Group NORTH SHORE RADIOLOGY ASSOCIATES OF MADISON SC Pharmacy NORTHEAST FAMILY PRACTICE Pharmacy OCONNELL PHARMACY LTD Pharmacy OREGON HOMETOWN PHARMACY Physician PETER S KAROFSKY, MD Pharmacy PICK N SAVE PHARMACY #6390 Pharmacy PINNACLE PHARMACY OF MADISON Page 14 of 114
SFY 2007
SFY 2008
SFY 2009 $51 $1,859 $90
$5,020 $221
$2,970
SFY 2010 $270 $447 $8,083 $839 $37
$30 $193
$212 $84 $300 $4,715 $129 $1,896 $55 $37 $996 $320 $538 $546 $472 $1,458
$22 $35 $216 $563 $209 $8,889 $273 $3,547 $37 $609 $542 $624 $198 $121 $42
$146 $482 $441 $47,691 $491 $3,839 $22 $57 $891 $23 $928 $216 $141 $169 $19
$304 $48 $73 $628 $186 $278 $1,149 $558 $97,705 $540 $7,270 $748 $562 $33 $49 $366 $1,036 $148
Total $321 $447 $17,931 $311 $839 $37 $30 $497 $48 $73 $797 $221 $1,189 $2,237 $1,068 $159,000 $1,434 $16,552 $861 $37 $2,223 $1,787 $72 $2,456 $960 $1,771 $1,500 $318 $19
Billing Provider Name Billing Provider Type Family Planning Clinic PLANNED PARENTHOOD Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Dentist RONALD M WANEK, DDS Nurse Practitioner SANDRA K ROOF, NP Pharmacy SHAFER PHARMACY INC Pharmacy SHOPKO PHARMACY #2029 Pharmacy SHOPKO PHARMACY #2032 Pharmacy SHOPKO PHARMACY #2034 Pharmacy SHOPKO PHARMACY #2080 Hospital ST MARYS HOSPITAL Independent Lab Dentist STEVEN D PETERSON, DDS Physician Group STOUGHTON HOSPITAL ASSN Hospital STOUGHTON HOSPITAL ASSOC Pharmacy TARGET STORE T-1060 PHARMACY Pharmacy TARGET STORE T-1069 Pharmacy TARGET STORE T-2106 PHARMACY Pharmacy TARGET STORE T-2491 PHARMACY Dentist TERRY A BURKE, DDS Dentist THOMAS P KUHN, DDS Hospital UNIV OF WIS HOSPITAL &CL Independent Lab UNIVERSITY OF WISCONSIN HOSP Physician Group UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION Physician Group UNIVERSITY OF WISCONSIN SYSTEMS ADMINISTRATION Pharmacy UNIVERSITY STATION PHARMACY UW HEALTH CHILDRENS PHARMACY Pharmacy Pharmacy UW HEALTH EAST PHARMACY UW HEALTH ONCOLOGY PHARMACY Pharmacy UW HEALTH OUTPATIENT PHARMAC Pharmacy Page 15 of 114
SFY 2007 $882,948 $150,462 $808 $57 $1,398 $212 $264 $452 $1,048 $2,798 $495 $1,008 $2,517
SFY 2008 $891,764 $130,509
SFY 2009 $314,794 $97,743
SFY 2010 $188,639 $216,744
$487 $280 $850 $695 $3,237 $1,046 $7,752 $2,443 $1,650 $992 $730 $1,208 $4,734 $48,448 $1,388
$89 $989 $829 $1,030 $41,175 $4,436 $340 $910 $23,433 $2,252 $1,961 $2,075 $131 $67 $26,215 $19,556 $742 $87 $236
$931 $126 $332 $10,626 $6,210 $1,148 $32,320 $5,749 $1,880 $1,972 $550
$193 $954 $1,159 $48,958 $414 $88 $161 $278
$84,743 $351 $67,775 $1,280 $13 $123 $29 $669
$240
$312
Total $2,278,145 $595,458 $808 $57 $89 $3,804 $1,446 $264 $2,665 $53,545 $16,682 $340 $3,600 $64,513 $12,961 $5,491 $5,040 $681 $923 $2,229 $116,850 $351 $184,736 $3,824 $175 $249 $283 $29 $1,499
Billing Provider Name UW HEALTH PHARMACY SERVICES UW HEALTH WEST PHARMACY UW MEDICAL FOUNDATION BELLEV UW MEDICAL FOUNDATION INC UW MEDICAL FOUNDATION NORTHE UW MEDICAL FOUNDATION VERONA UW MEDICAL FOUNDATION WINGRA UW SYSTEMS UW SYSTEMS NORTHEAST UW SYSTEMS WINGRA VERONA HOMETOWN PHARMACY VILLAGE PHARMACY & GIFTS WALGREENS #01159 WALGREENS #02848 WALGREENS #02967 WALGREENS #03291 WALGREENS #03329 WALGREENS #03343 WALGREENS #09741 WALGREENS #10554 WALGREENS #10555 WALGREENS #10573 WALGREENS #10925 WALGREENS #11648 WALGREENS #11858 WALGREENS #12603 WALGREENS 02879 WALGREENS 03393 WALGREENS 04155
Billing Provider Type Pharmacy Pharmacy Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Page 16 of 114
SFY 2007 $24,496 $666 $30 $2,367 $661 $3,065 $27 $619 $2,045 $227 $281 $1,405 $6,595 $4,483 $3,487 $2,943 $4,670 $1,600 $3,917
SFY 2008 $48,907 $355 $103 $1,466 $601 $1,625 $78 $270 $370 $386 $30 $2,990 $5,639 $2,765 $7,489 $2,320 $4,586 $1,863 $1,182 $3,680 $1,045 $2,307
SFY 2009 $35,707 $361
SFY 2010 $31,072
$7,408 $1,348 $8,912
$7,127 $1,409 $13,577
$160 $121 $5,127 $4,195 $4,129 $4,658 $2,179 $3,634 $2,060 $1,244 $6,030 $1,585 $1,010 $674 $6,489 $170 $9,382 $682 $9,046
$366 $380 $2,429 $7,669 $6,023 $8,076 $2,131 $7,272 $3,970 $2,265 $4,009 $2,786 $6,631 $1,961 $14,221 $3,347 $9,441 $1,049 $18,279
Total $140,182 $716 $769 $30 $3,834 $1,262 $4,690 $105 $888 $2,415 $1,139 $811 $11,951 $24,098 $17,399 $23,710 $9,573 $20,162 $9,493 $4,691 $17,635 $5,416 $9,949 $2,636 $20,710 $3,517 $33,359 $4,488 $49,813
Dodge
Billing Provider Name Billing Provider Type Pharmacy WALGREENS 04805 Pharmacy WALGREENS 04830 Pharmacy WALGREENS 05087 Pharmacy WALGREENS 05669 Pharmacy WALGREENS 06130 Pharmacy WALGREENS 06132 Pharmacy WALGREENS 07519 Pharmacy WALGREENS 07536 Pharmacy WALGREENS 09740 Pharmacy WALGREENS04240 Pharmacy WALGREENS05233 Pharmacy WAL-MART PHARMACY 10-1138 Pharmacy WAL-MART PHARMACY 10-1176 Pharmacy WAL-MART PHARMACY 10-1267 Pharmacy WAL-MART PHARMACY 10-3857 Pharmacy WAL-MART PHARMACY-10 2335 Physician Group WILDWOOD FAMILY CLINIC SC Physician WILLIAM B HOBBINS, MD Physician WILLIAM E FOWLER, MD Physician Group WISCONSIN HEART SC Physician Group WISCONSIN PATHOLOGISTS SC AGNESIAN PHARMACY BROWNSVILL Pharmacy Pharmacy AGNESIAN PHARMACY MAYVILLE Physician Group AMERIPATH MILWAUKEE SC Pharmacy AURORA PHARMACY INC Physician Group AYAZ M SAMADANI MD SC Physician Group BDCH INC MEDICAL CLINICS BEAVER DAM COMMUNITY HOSPITALS Hospital INC Physician Group BEAVER DAM ORTHOPAEDICCLINIC Page 17 of 114
SFY 2007 $2,667 $2,773 $2,434 $1,274 $4,420 $4,974 $1,215 $3,252 $3,450 $11,105 $2,176 $1,404 $1,694 $898 $1,405 $77 $55 $94 $276
SFY 2008 $3,158 $3,457 $6,688 $1,600 $10,575 $6,454 $2,257 $3,975 $2,125 $14,367 $2,742 $2,144 $954 $785 $518 $1,277 $104
SFY 2009 $1,673 $2,421 $7,112 $770 $11,348 $9,859 $2,381 $2,315 $1,830 $8,973 $1,990 $3,698 $1,976 $1,409 $3,957 $4,998 $119
SFY 2010 $4,310 $1,557 $3,681 $4,593 $7,786 $9,523 $4,618 $1,399 $3,724 $10,986 $5,217 $3,742 $2,746 $2,650 $6,472 $3,452 $871 $78 $101 $691 $570 $40 $1,920 $304 $37 $55 $29,461 $30
$78 $325
$30 $119
$2,840 $1,308
$1,995 $444
$2,062 $1,612
$261
$279
$8,019
Total $11,808 $10,208 $19,916 $8,236 $34,129 $30,811 $10,472 $10,941 $11,129 $45,431 $12,125 $10,988 $7,370 $5,742 $10,947 $11,131 $1,171 $55 $78 $303 $1,411 $570 $40 $8,817 $3,667 $37 $55 $38,020 $30
Billing Provider Name BEAVER DAM REFERENCE LAB BEAVER DAM WOMENS HEALTH LTD CENTRAL OTOLOGIC LTD CONSULTANTS LABORATORYOF
Billing Provider Type Independent Lab Physician Group Physician Group Independent Lab Mental Health and Substance Abuse Services DIRECTIONS COUNSELING CENTER Physician DOUGLAS E BRICKER, MD Physician Group FAMILY & SPORTS ORTHOPAEDIC Physician Group IHC-BEAVER DAM EMERGENCY PHYSICIANS, LLC Physician Group INTEGRITY UROLOGIC SC Physician JAMES E MEADE, MD Physician JEFFERY A MEADE, MD Nurse Practitioner JULEE R RADTKE, NP Physician KEVIN L OHALLORAN, MD Physician LAEEKHA A ALI, MD Pharmacy MARSHLAND PHARMACY Physician Group MEADE MEDICALCLINIC Physician Group METROPOLITANWATERTOWNLLC Family PLANNED PARENTHHOOD OF WISCONSIN, INC.Planning Clinic Physician Group RADIOLOGY ASSOC BEAVERDAM Physician Group RANDOLPH COMMUNITY CLINIC SC Pharmacy SHOPKO PHARMACY #2014 Physician Group ST MARYS DEAN VENTURES INC Physician Group TARA L PASSOW MD INC Physician TERRY L TURKE, MD Pharmacy THRIFTY WHITEDRUG #48 Physician UWHP WRMC CENTER FOR WOMEN'S HEALTH Group UWHP WRMC DOCTORS COURT CLINIC Physician Group Page 18 of 114
SFY 2007 $1,597 $3,313 $21
SFY 2008 $2,013 $3,225 $32
SFY 2009 $1,348 $1,248 $33
SFY 2010 $1,842 $3,611 $30
Total $6,799 $11,396 $30 $85
$100 $12 $87 $535 $230 $171 $264 $55
$461 $196 $30 $133 $63
$86 $2,232 $65 $3,336 $2,126 $113 $100,846 $10 $36 $3,880 $3,346 $27 $233 $2,998 $22 $6,001 $625 $30 $34,494 $162 $114 $2,024 $6,693 $22 $396 $964 $2,295
$137,950 $113 $5,308 $4,009 $27 $2,336 $2,146
$103,321 $10 $62 $4,138 $4,039 $51 $3,966 $1,689 $60
$100 $12 $258 $1,260 $55 $488 $30 $133 $86 $65 $13,695 $738 $30 $376,612 $182 $326 $15,350 $18,088 $22 $501 $7,498 $9,128 $82
Door
Billing Provider Name Billing Provider Type Physician UWHP WRMC HEART AND VASCULAR CENTER Group Physician Group UWHP WRMC INTERNAL MEDICINE CLINIC Physician Group UWHP WRMC JUNEAU CLINIC Pharmacy VANS CORNER DRUG INC Physician VICTOR W CACERES, MD Pharmacy VILLAGE PHARMACY Physician Group VITA PARK EYE ASSOCIATES SC Pharmacy WALGREENS #11253 Pharmacy WALGREENS #11649 Pharmacy WAL-MART PHARMACY 10-1012 Pharmacy WAL-MART PHARMACY 10-5463 WATERTOWN EMERGENCY PHYSICIA Physician Group Physician Group WATERTOWN FAMILY PRACTICE Physician Group WATERTOWN INTERNAL MEDICINE Independent Lab WATERTOWN MEMORIAL HOSPITAL Hospital WATERTOWN REGIONAL MEDICAL CENTER INC Hospital WAUPUN MEMORIAL HOSPITAL Physician Group AURORA HEALTH CENTER Rural Health Clinic AURORA HEALTHCENTER Rural Health Clinic AURORA NOR DOOR CLINIC Pharmacy AURORA PHARMACY INC Pharmacy BAY PHARMACY Family Planning Clinic COMMUNITY CLINIC OF DOOR Physician DERMATOLOGY ASSOCIATES OF WISCONSIN SC Group Hospital DOOR CO MEMORIAL HOSPITAL Physician Group DOOR COUNTY MEMORIAL HOSP Independent Lab DOOR COUNTY MEMORIAL HOSPITA Rural Health Clinic DOOR COUNTY MEMORIAL HOSPITAL Rural Health Clinic Page 19 of 114
SFY 2007
SFY 2008
SFY 2009 $140 $289 $893 $190
$43 $2,508 $221
$100 $2,841 $138 $226 $1,694
SFY 2010 $30 $61 $961 $167 $74 $4,591 $4,576 $6,253 $5,747 $343 $916 $3,401 $18,801 $4,504 $4,000 $166 $1,624 $5,071 $193 $13,645 $3,532 $274 $187 $5,430
Total $30 $200 $1,393 $6,241 $715 $226 $74 $10,118 $6,991 $14,922 $6,960 $1,672 $1,261 $491 $8,405 $39,433 $8,333 $6,331 $346 $254 $3,616 $25,439 $21,577 $288 $38,307 $9,641 $1,041 $475 $5,430
$476 $756 $204 $314 $1,388 $311 $244 $1,125 $126 $87 $898 $9,565 $12,044 $3,240
$3,272 $100 $311 $30 $177 $1,851 $2,335 $751 $590 $220 $703 $6,993 $8,053 $7,535 $3,004 $638
$3,833 $2,414 $4,921 $1,112 $262 $112 $1,765 $17,985 $2,834 $616
$392 $3,810 $1,480 $95 $13,886 $3,105 $129 $288
Douglas
Dunn
Billing Provider Name Billing Provider Type Physician KAREN L BUTLER, MD Physician Group LAKE SIDE SURGICAL ASSOCIATE Nurse Practitioner MICHELE GEIGER BRONSKY, NP Pharmacy PAMIDA PHARMACY #653 Pharmacy SISTER BAY PHARMACY INC Pharmacy WALGREENS 07635 Pharmacy WAL-MART PHARMACY 10-1316 WELLNESS CENTER OF DOOR COUNTY Family Planning Clinic Nurse WELLNESS CENTER OF DOOR COUNTY INC Practitioner Family Planning Clinic DOUGLAS CO COMMUNITY HLTH Pharmacy DULUTH CLINICSUPERIOR PHARMA Physician ESSENTIA HEALTH ST MARYS- SUPERIOR CLINICGroup Pharmacy FALKS LIGNELLPHARMACY Pharmacy K MART PHARMACY 7206 Federally Qualified Health Clinic (FQHC) LAKE SUPERIOR COMMUNITY HLTH Physician Group MARINER MEDICAL CLINIC Pharmacy PEOPLES DRUGSTORE SMDC CLINICALLABORATORYSUPER Independent Lab Hospital ST MARYS HOSPITAL OF SUPERIOR Physician Group SUPERIOR CLINIC Pharmacy TARGET T 889PHARMACY Pharmacy WALGREENS#03064 Pharmacy WAL-MART PHARMACY 10-1447 Pharmacy COLFAX HEALTH MART PHARMACY Pharmacy COLFAX PHARMACY Family Planning Clinic DUNN COUNTY PUBLIC HLTH Pharmacy ERICKSON FAMILY PHARMACY Pharmacy K MART PHARMACY 3541 Page 20 of 114
SFY 2007 $830
SFY 2008 $94 $22 $2,507 $1,678 $9,904 $9,144 $142,079 $129,879 $3,629 $2,444 $1,907 $695 $3,052 $577 $883 $182
SFY 2009 $22 $27 $1,811 $6,816 $12,682 $173,635
SFY 2010 $937 $420 $1,061 $5,800 $9,072 $285,008 $1,033 $4,477 $4,383 $3,376 $1,034 $7,351 $1,238 $33 $546 $16,003 $2,468 $20,948 $5,773 $150 $140,384 $1,374 $1,768
$2,073 $6,870 $7,793 $133,393 $197,900 $4,759 $2,927 $1,236 $837 $3,928 $526 $672 $89 $121 $3,442 $15,394 $3,949 $405 $117,058 $1,299 $207
$5,449 $3,524 $1,924 $1,567 $3,954 $1,085 $159 $242 $435 $4,176 $21,822 $6,615 $357 $101,060 $1,223 $1,866
Total $1,883 $441 $27 $5,379 $3,750 $29,390 $38,691 $734,115 $1,033 $327,779 $18,313 $13,277 $8,442 $4,133 $18,285 $3,426 $1,747 $1,058 $16,438 $121 $15,566 $76,766 $21,881 $862 $444 $465,381 $5,485 $4,823
$5,480 $18,603 $5,543 $354 $39 $106,879 $1,590 $982
Eau Claire
Billing Provider Name Billing Provider Type SFY 2007 Physician LYNN M MUREL, MD Independent Lab MARSHFIELD CLINIC MENOMONIE $73 Hospital MAYO CLINIC HEALTH SYSTEM RED CEDAR $1,127 Physician Group MAYO CLINIC HEALTH SYSTEM RED CEDAR- ELMWOOD CLINI Physician Group MAYO CLINIC HEALTH SYSTEM RED CEDAR- GLENWOOD CITY $43 Pharmacy MEDICINE SHOPPE 1685 $7,577 Pharmacy RED CEDAR MEDICAL CENTER $3,964 Independent Lab RED CEDAR MEDICAL CENTER INC $47 Physician Group $9,090 Pharmacy THE MEDICINE SHOPPE #527 $1,318 Family Planning Clinic UNIVERSITY OF WISCONSIN $102,170 Pharmacy WALGREENS 09514 $8,137 Pharmacy WAL-MART PHARMACY 10-1819 $8,766 Nurse Service BECKY L KAHLER THYSSEN, CNM Physician CARYN I SCHULZ, MD $30 Physician Group CHIPPEWA VALLEY ORTHOPEDICS Physician Group DECESARE ORTHOPEDIC CLINIC EAU CLAIRE ANESTHESIOLOGISTS LTD Anesthetist Physician Group Family Planning Clinic EAU CLAIRE FAMILY PLANNING $141,205 Physician Group EAU CLAIRE GIASSOCIATES SC Pharmacy EAU CLAIRE HEALTH MARTPHARM $12 Independent Lab EAU CLAIRE MEDICAL CLINIC Physician Group $28 Pharmacy EAU CLAIRE PHARMACY $322 Physician Group EAU CLAIRE WOMENS CARE $2,395 Physician EDGAR O HICKS, MD Pharmacy GROUP HEALTHOAKWOOD HILLS $1,164 GROUP HEALTHPUTNAM PHARMACY Pharmacy $26,439 Page 21 of 114
SFY 2008 $21 $2,892 $143 $153 $10,680 $3,840 $9,259 $1,663 $119,538 $11,891 $12,439
SFY 2009 $11 $13,645 $179 $94 $6,392 $2,076 $8,268 $498 $102,864 $21,400 $13,108 $5,311
SFY 2010 $291 $21 $14,048 $89 $554 $8,763 $1,928 $287 $13,400 $1,036 $82,461 $22,145 $18,439
$149,041 $478
$141,502 $2,642 $95
$226 $101 $118 $84 $174,648 $22 $1,446 $105 $773 $3,673 $78 $1,998
$1,905 $55 $26,208
$2,742 $30 $16,270
Total $291 $126 $31,712 $411 $843 $33,412 $11,810 $335 $40,017 $4,514 $407,032 $63,574 $52,751 $5,311 $30 $226 $101 $118 $84 $606,397 $22 $4,578 $105 $896 $322 $10,715 $163 $1,164 $70,914
Billing Provider Name GROUP HEALTHRIVERVIEW IRFANE M KHATIB, MD JAMIE N LAMM, NP JENIFER I BASSETT, MD JOHN C MERRICK, MD K MART PHARMACY 4051 LINDA POIRIER, NP MARSHFIELD CLINIC EAU
Billing Provider Type SFY 2007 Pharmacy $1,033 Physician $1,106 Nurse Practitioner Physician Physician Pharmacy $2,628 Nurse Practitioner $3,781 Independent Lab $2,109 Ambulatory Surgical Center (ASC) MARSHFIELD CLINIC EAU CLAIRE Independent Lab MARSHFIELD CLINIC OAKWOOD $156 Pharmacy MARSHFIELD CLINIC PHARMACY $13,275 Independent Lab MARSHFIELD CLINIC RIVERVIEW CENTER LAB $52 Independent Lab MARSHFIELD CLINIC STRATFORD Physician Group MAYO CLINIC HEALTH SYSTEM EAU CLAIRE CLINIC INC $3,463 Hospital MAYO CLINIC HEALTH SYSTEM EAU CLAIRE- LUTHER CAMPU $119 Independent Lab $2,321 Pharmacy MAYO CLINIC HEALTH SYSTEM PHARMACY & HOME MEDICAL $2,918 Physician Group MEDICAL X RAY CONSULTANTS NORTHERN PINES EAR NOSE & THROAT Physician Group SC Hospital OAKLEAF SURGICAL HOSPITAL $66 Physician Group OBSTETRICS GYNECOLOGY CLINIC OF EAU CLAIRE SC Physician Group PAIN CLINIC OF NORTHWESTERN $28 Physician Group PATHOLOGY SC $3,981 Nurse Practitioner PATRICIA T SONTAG, NP Physician Group PINE GROVE FAMILY PRACTICE $176 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician RICHARD J DANIELS, MD Hospital SACRED HEART HOSPITAL $340 Page 22 of 114
SFY 2008 $789
SFY 2009 $115 $34
SFY 2010
$4,316 $4,763 $3,256 $207 $42 $16,432 $21 $4,386 $119 $1,758 $3,604 $74
$2,338 $2,267 $1,985 $207 $43 $17,719
$95 $37 $3,819 $5,562
Total $1,033 $2,010 $34 $95 $37 $13,100 $10,811 $12,912 $414 $369 $69,232 $84 $23 $33,363 $32,897 $17,001 $16,797 $573 $48 $7,589 $1,046 $663 $12,566 $369 $1,613 $151,151 $37 $39,415
$2,609 $5,802 $2,716 $4,300 $121
$3,504 $159
$260 $135 $1,491 $378 $31,792 $10,086
$1,593
$129 $21,805 $11 $23 $22,905 $26,857 $10,206 $5,975 $378 $48 $7,523 $785 $500 $3,590 $369 $901 $119,359 $37 $27,396
Florence Fond du Lac
Billing Provider Name SACRED HEARTHOSPITAL OF THE SHOPKO PHARMACY #2024 STEVEN C IMMERMAN, MD STEVEN D STENZEL, MD SUSAN J MOMONT, MD TARGET STORE T-1774 PHARMACY THOMAS P PELLER MD SC THOMAS P PELLER, MD U OF WISCONSIN EAU CLAIRE UW MEDICAL FOUNDTION EAU CLA VALUE CENTERHEALTH MART PHA VALUE CENTERPHARMACY WALGREENS #03497 WALGREENS 01937 WALLY SHONG HEALTH MART WAL-MART PHARMACY 10-1669 WESTERN WISCONSIN UROLOGY WILLOW CREEK WOMENS CLINIC FLORENCE MEDICAL CENTER
Billing Provider Type Independent Lab Pharmacy Physician Physician Physician Pharmacy Physician Group Physician Family Planning Clinic Physician Group Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Group Nurse Practitioner Physician Group Rural Health Clinic Pharmacy AGNESIAN PHARMACY AGNESIAN PHARMACY MERCURY MA Pharmacy Pharmacy AGNESIAN PHARMACY NFDL Pharmacy AGNESIAN PHARMACY WAUPUN Physician Group AURORA HEALTH CENTER Pharmacy AURORA PHARMACY INC Dentist BROWN H OTOPALIK, DDS Physician Group CHN MEDICAL CENTER RIPON Physician Group CLINIC OF ORTHOPEDIC SURGERY Page 23 of 114
SFY 2007 $5,220 $15,581 $302 $533 $6,254
SFY 2008 $4,182 $14,861 $967 $7,894
SFY 2009 $4,532 $13,347 $95 $6,802
SFY 2010 $5,474 $22,265 $37
$350,167 $4,966 $133 $728 $27,140 $13,388 $179 $4,531
$356,332 $3,538 $839 $33,505 $16,976 $705 $7,649
$406,359 $28 $38,284 $16,269 $1,396 $10,413 $11 $603 $22 $987 $2,676 $50 $33 $1,393 $1,520 $1,375 $12
$7,974 $92 $55 $341,505
$49,270 $25,600 $1,379 $13,764 $141 $8,113 $1,336 $1,864 $279 $2,157 $3,523 $793 $702 $77
$547 $747 $4,272 $120 $631 $2,338 $2,595 $1,092 $360 $174
$140 $1,391 $3,999 $207 $257 $1,476 $2,300 $1,066 $200
Total $19,409 $66,054 $37 $1,364 $533 $28,924 $92 $55 $1,454,363 $8,504 $1,001 $728 $148,198 $72,233 $3,659 $36,357 $152 $8,715 $710 $4,461 $12,811 $656 $922 $7,365 $9,938 $4,326 $360 $1,089 $77
Forest
Billing Provider Name Billing Provider Type Independent Lab CONSULTANTS LABORATORYOF Independent Lab CONSULTANTS LABORATORYOF WI Pharmacy CONSUMER PRESCRIPTION CENTER Physician DERMATOLOGY ASSOCIATES OF WISCONSIN SC Group Physician Group FOND DU LAC PATHOLOGY CONSUL Physician Group FOND DU LAC REGIONAL CLINIC Pharmacy K MART PHARMACY 7649 Pharmacy KREMER PHARMACY Pharmacy PAMIDA PHARMACY 249 Physician PAUL A BOEDER, MD Pharmacy PHARMACY PLUS Pharmacy PICK N SAVE PHARMACY #6389 Family PLANNED PARENTHOOD OF WISCONSIN, INC Planning Clinic RIPON DRUG MANAGEMENT ENTERP Pharmacy Hospital RIPON MEDICAL CENTER Independent Lab Physician Group Pharmacy SHOPKO PHARMACY #2050 Hospital ST AGNES HOSPITAL Pharmacy TARGET STORE T-0808 PHARMACY Pharmacy THE VILLAGE APOTHECARYINC Pharmacy WALGREENS #01164 Pharmacy WALGREENS #10496 Pharmacy WALGREENS #10927 Pharmacy WAL-MART PHARMACY 10-1643 Federally Qualified Health Clinic (FQHC) FOREST COUNTY POTAWATOMI Pharmacy PAUL LINDERUD DBA CRANDON REXALL PHARMACY Pharmacy PAUL LINDERUD DBA LAONA PHARMACY Page 24 of 114
SFY 2007 $15,995 $21 $1,127 $3,178 $19,154 $1,638 $590 $285 $2,654 $722 $323,241 $2,179 $510
SFY 2008 $18,908 $137 $776 $3,696 $20,261 $651 $134
SFY 2009 $20,441 $53 $348 $2,788 $18,501 $720 $476
SFY 2010 $23,204
$563 $3,856 $36,959 $1,312 $1,294 $937 $2,580 $62,210 $973 $6,487 $103 $121 $3,805 $14,472 $815 $418 $6,954 $25,254 $6,437 $8,743 $395 $1,636 $781
$883 $1,080 $280,287 $1,726 $1,285
$1,655 $193 $152,733 $294 $2,869 $23 $3,285 $13,370 $698 $404 $4,963 $22,007 $2,873 $6,383
$4,470 $983 $37 $3,312 $19,696 $3,628 $600 $244 $463
$3,126 $7,259 $404 $236 $4,292 $21,445 $2,450 $4,881 $438 $189 $762
Total $78,548 $211 $2,251 $563 $13,518 $94,876 $4,321 $2,494 $285 $937 $7,773 $1,995 $818,471 $5,171 $11,151 $126 $121 $14,685 $36,083 $1,955 $1,057 $19,522 $88,402 $11,760 $23,635 $1,434 $2,443 $2,727
$374 $721
Grant
Billing Provider Type Federally Qualified SOKAOGON CHIPPEWA HEALTH CLINIC Health Clinic (FQHC) Pharmacy WOLF RIVER PHARMACY Rural Health Clinic BLUFF STREETCLINIC Pharmacy BOHLMAN DRUGSTORE INC Hospital BOSCOBEL AREA HEALTH CARE Independent Lab Physician Group Physician Group BOSCOBEL AREAHEALTH CARE Physician Group BOSCOBEL CLINIC SC Anesthetist C & M ASSOCIATES INC Pharmacy CARDINS PHARMACY Anesthetist DAVID C BAINBRIDGE, CRNA Pharmacy DOCTORS PARKPHARMACY Physician GENE P WEGNER, MD Physician GERT H HASSELHOF, MD Hospital GRANT REGIONAL HEALTH CENTER Independent Lab Physician Group Pharmacy HARTIG DRUG CO #15 Pharmacy HARTIG DRUG CO INC Physician Group HIGH POINT FAMILY MEDICINE Pharmacy K MART PHARMACY 3970 Physician Group LANCASTER FAMILY MEDICAL Physician MEENAKSHI R MASKI, MD Rural Health Clinic MUSCODA HEALTH CENTER Pharmacy PAMIDA PHARMACY #387 Rural Health Clinic POTOSI TENNYSON MEDICAL Physician RAVIKANT MASKI, MD Page 25 of 114
SFY 2007 $240 $1,485 $57 $1,927 $97 $30 $1,660 $64 $1,046 $57 $134 $79 $2,644 $4,875 $4,957 $308 $198 $27 $1,270 $62 $139
SFY 2008 $130 $1,205 $36 $2,069 $310
SFY 2009 $219 $73 $1,342 $3,533 $63 $367 $699 $399 $144 $106 $23 $1,491 $38 $2,857 $6,693 $132 $6,985 $63 $86 $116 $1,850
SFY 2010 $595 $1,193 $288 $2,004 $2,192 $271 $79 $302 $1,474 $2,166 $328
Total $1,184 $3,956 $381 $7,342 $6,035 $431 $446 $412 $4,496 $47 $2,661 $144 $1,815 $35 $57 $5,904 $308 $145 $10,049 $21,285 $526 $20,706 $1,091 $853 $1,198 $5,857 $62 $367
$80 $663 $47 $32 $336 $12 $387 $137 $2,881 $3,349 $143 $5,349 $444 $77 $172 $1,386 $52
$4,026 $66 $1,667 $6,369 $251 $3,416 $277 $492 $884 $1,350 $176
Billing Provider Name SCOTT A WALKER, MD SOUTHWEST COMMUNITY ACTION SOUTHWEST HEALTH CENTER
Green
Green Lake
Billing Provider Type Physician Family Planning Clinic Hospital Independent Lab Physician Group Physician Group ST MARYS DEAN VENTURES INC Family Planning Clinic U OF WI PLATTEVILLE STUDENT Pharmacy WALGREENS #12498 Pharmacy WAL-MART PHARMACY 10-0958 Transportation ANGLIN TRANSPORT SERVICES IN NEW GLARUS HOMETOWN PHARMACY Pharmacy Pharmacy PINNOW PHARMACY INC Family Planning Clinic PLANNED PARENTHOOD OF WI Pharmacy SCHULTZ PHARMACY Pharmacy SHOPKO PHARMACY #2120 Pharmacy THE CLINIC PHARMACY Pharmacy THE MEDICINEMART Physician Group THE MONROE CLINIC Pharmacy THE MONROE CLINIC HOSPITAL Hospital THE MONROE CLINIC INC Independent Lab Pharmacy WALGREENS #11647 Pharmacy WAL-MART PHARMACY 10-0802 Pharmacy BENTLEY PHARMACIES INC. Hospital BERLIN MEMORIAL HOSPITAL Independent Lab Anesthetist CENTRAL WISCONSIN ANESTHESIO Physician Group CHN DR GUBITZ Physician Group CHN MEDICAL CENTER BERLIN Page 26 of 114
SFY 2007 $30 $229,566 $165 $42 $3,163 $66,853 $12,330 $249 $1,902 $1,478 $4,882 $4,758 $489 $4,819 $183 $1,588 $342 $3,469 $1,286 $1,774 $3,942 $174 $1,958
SFY 2008 $211,795 $769 $30 $65 $6,984 $64,747 $29,386 $1,084 $2,156 $1,142 $4,626 $5,047 $90 $6,042 $195 $6,045
SFY 2009 $182,250 $11,977 $77 $179 $5,272 $72,522 $9,430 $33,684 $21 $289 $2,129 $776 $486 $3,028 $4,366 $4,329 $8,942 $766 $6,831 $291 $17,476 $2,514
SFY 2010 $416,158 $16,653 $815 $264 $14,172 $65,291 $12,655 $23,522 $456 $1,797 $61 $884 $2,066 $3,764 $131 $7,150 $20,473 $2,078 $6,740 $576 $12,288 $3,061 $131 $124 $4,000
Total $30 $1,039,768 $29,564 $964 $507 $29,591 $269,413 $22,085 $98,922 $21 $2,077 $7,984 $837 $3,990 $14,601 $17,934 $710 $22,341 $378 $37,048 $342 $2,844 $23,276 $3,107 $37,229 $12,395 $495 $124 $11,754
$6,235 $954 $5,690 $2,878 $190 $1,930
$3,867
Illinois
Billing Provider Name Billing Provider Type CHN MEDICAL CENTER GREEN LAKE Physician Group Physician Group CHN MEDICAL CENTER INTERNAL MEDICINE Physician Group CHN MEDICAL CENTER MARKESAN Physician Group CHN MEDICAL CENTER PRINCETON Physician CHN MEDICAL CENTER PULMONARY & SLEEP Group Physician Group CHN MEDICAL CTR EASTRIDGE Physician Group CHN OB/GYN Physician Group CHN ORTHOPEDICS AND SPORTS MEDICINE Physician Group CHN RADIOLOGY Physician LLC COMMUNITY MEDICAL CENTER OF GREEN LAKEGroup Physician DAVID E RESEN, MD Physician DAVID R JONES, MD Pharmacy FIELD PHARMACY LLC Pharmacy MARKESAN PHARMACY Physician Group RIPON MEDICAL CENTER Physician Group ROGERS NELSON AND LO SURGICAL ASSOCIATES Pharmacy WAL-MART PHARMACY 10-1727 WOMENS HEALTH & RESOURCE CEN Family Planning Clinic FHN LEONARD C FERGUSONCANCER Physician Group Hospital FREEPORT MEMORIAL HOSPITAL Physician GAUTAM GUPTA, MD Physician GUY R ABDERHOLDEN, MD Pharmacy NIHAN & MARTIN PHARMACY Physician Group NORTHPOINTE HEALTH Independent Lab QUEST DIAGNOSTICS LLC IL Physician Group ROCKFORD HEALTH PHYSICIANS Hospital SAINT ANTHONY MEDICAL CENTER Hospital SWEDISH AMERICAN HOSPITAL Pharmacy WALGREENS 02003 Page 27 of 114
SFY 2007 $196 $279 $57 $343 $1,749
SFY 2008 $97 $150 $72 $87 $313 $377
SFY 2009
SFY 2010 $528 $36 $1,137 $270 $647 $86 $62 $76 $239 $2,071 $777 $402 $37 $7,651 $42,186
$16 $105 $105
$1,535 $43 $3,672 $1,070
$1,181 $22 $3,487 $2,696
$719 $3,545 $747
$4,250 $20,748
$6,141 $19,445
$5,956 $19,221 $48 $32
$120 $30 $58 $160 $24,531 $23 $1,496 $503 $610 $113 $200 $86 $46,447
$19,144 $93
$19,866
Total $293 $678 $403 $1,281 $375 $1,408 $2,126 $86 $62 $76 $3,674 $65 $12,774 $5,290 $402 $37 $23,998 $101,600 $48 $32 $120 $30 $58 $247 $109,989 $93 $23 $113 $2,808
Iowa
Billing Provider Name WALGREENS 02585 WALGREENS 05829 WALGREENS 06001 WALGREENS 06002 WALGREENS 3322 WAL-MART PHARMACY 10-5044 WAL-MART PHARMACY 10-5199 WARREN DRUG STORE BLACKHAWK AREA HEALTH CARE CORNER DRUG HOMETOWN PHARMAC DOUGLAS R PALMER, MD EVERETT R LINDSEY, MD GARY J GRUNOW MD, MD GORDON J GRIESHABER MD, MD IVEYS PHARMACY INC KENT S KRAMER M D, MD MARK P BISHOP MD, MD MICHELE A ROELLI MD, MD MINERAL POINT MEDICAL CENTER PAMELA K RICE, MD SARAH E FOX MD, MD SWANSON PHARMACY INC UPLAND HILLSHEALTH UPLAND HILLSHEALTH INC WALGREENS #10962 WAL-MART PHARMACY 10-0847 DOUGLAS A SCHMID, MD DUBUQUE INTERNAL MEDICINE PC
Iowa State
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Group Pharmacy Physician Physician Physician Physician Pharmacy Physician Physician Physician Rural Health Clinic Physician Physician Pharmacy Hospital Independent Lab Physician Group Pharmacy Pharmacy Physician Physician Group Page 28 of 114
SFY 2007 $79 $282 $19 $52 $190
SFY 2008
SFY 2009 $13 $774
SFY 2010
Total $13 $79 $1,751 $30 $263 $555 $597 $287 $108 $2,570 $22 $61 $548 $211 $3,401 $88 $280 $560 $385 $104 $132 $290 $5,997 $395 $180 $6,851 $14,465 $95 $30
$264
$149 $622 $22 $147 $848 $320
$154 $372 $97 $30 $470
$432 $11 $211 $210 $225 $40 $78 $1,159 $61 $287 $181 $664 $30 $223 $443 $61 $132
$57 $30 $902 $57 $117 $60 $57
$58 $988 $58
$150 $47 $290 $251
$114
$494
$14 $2,423
$1,982 $5,430 $30
$2,430 $80 $79 $2,126 $3,017
$2,821 $314 $101 $2,730 $3,595 $95
Iron
Jackson
Billing Provider Name Billing Provider Type Physician Group DUBUQUE RADIOLOGICAL ASSOCIATES, PC Physician Group GUNDERSEN CLINIC LTD Pharmacy HARTIG DRUG CO #2 Pharmacy HARTIG DRUG CO #4 Pharmacy HY VEE PHARMACY #3 1162 Physician Group MEDICAL ASSOCIATES CLINIC PC Pharmacy MERCY FAMILY PHARMACY EAST Physician Group PATHOLOGY ASSOCIATES Independent Lab UNITED CLINICAL LABORATORIES Pharmacy WALGREENS #09708 Pharmacy WALGREENS #11942 IRON COUNTY HEALTH DEPARTMENT Family Planning Clinic Mental Health and Substance Abuse Services IRON COUNTY HUMAN SERVICES Independent Lab MARSHFIELD CLINIC MERCER Physician Group Physician Group NORTHWOODS FAMILY ORTHO SC Pharmacy ROWE WHITE CROSS PHARMACY Pharmacy WHITE CROSS PHARMACY Pharmacy BLACK RIVER FALLS CLINIC Physician Group BLACK RIVER MEMORIAL HOSP Hospital BLACK RIVER MEMORIAL HOSPITA Federally Qualified Health Clinic (FQHC) HO CHUNK HEALTH CARE CENTER HO CHUNK HEALTHCARE PHARMACY Pharmacy Mental Health and Substance Abuse Services KROHN CLINICLTD Page 29 of 114
SFY 2007 $25 $340
SFY 2008
SFY 2009
SFY 2010 $22
Total $22 $25 $340 $234 $225 $2,422 $34 $37 $1,122 $1,098 $142 $95,253
$234 $225 $202 $34 $84 $191 $21,026 $365 $37 $207 $438 $19,717 $866 $989
$479
$20,921
$351 $469 $142 $33,590
$112 $10 $28 $22 $3,055 $889 $240 $851 $199 $2,146 $1,453
$45 $22 $230 $1,898 $1,534 $453 $285
$22 $671 $412 $1,541 $1,777 $91 $7,011 $369 $279
$157 $54 $930 $22 $7,511 $1,541 $5,654 $91 $7,703 $1,704 $279
$43
$43
Jefferson
Billing Provider Type SFY 2007 Physician Group $359 Podiatrist PAUL E HELSTAD, DPM Pharmacy WAARVIK DRUGS INC Pharmacy WAL-MART PHARMACY 10-1277 $1,605 Pharmacy AURORA PHARMACY INC $575 Physician Group FAMILY MEDICAL CLINIC $47 Physician Group FORT ATKINSON EMERGENCY PHYS $27 Hospital FORT HEALTHCARE INC $115 Physician Group $2,923 Independent Lab FORT MEMORIAL HOSPITAL $1,696 Anesthetist FORT MEMORIAL HOSPITALCRNA $143 Physician Group JEFFERSON Physician JEFFREY A SMITH, MD $37 Physician Group JOHNSON CREEK $154 Pharmacy K MART PHARMACY 9543 $846 Physician Group LAKE MILLS URGENT CARE $30 Pharmacy MUELLER DRUGS INC $1,906 Pharmacy PICK N SAVE PHARMACY #6888 $96 Family Planning Clinic PLANNED PARENTHOOD OF WI Physician Group PROHEALTH CARE MEDICAL ASSOCIATES $178 Physician RICHARD E NEILS, MD Pharmacy SHOPKO PHARMACY #2019 $753 Pharmacy SHOPKO PHARMACY #2051 $762 Physician THOMAS J TACKMAN, MD $60 Pharmacy TUTTLES PHARMACY INC $29 Physician Group UW HEALTH PARTNERS WATERTOWN REGIONAL MEDICAL CENT UWHP WRMC JOHNSON CREEK CLINIC Physician Group $60 Physician Group UWHP WRMC LAKE MILLS CLINIC $336 Physician Group UWHP WRMC WATERLOO CLINIC Page 30 of 114
SFY 2008 $325
SFY 2009 $388 $30 $2,841 $270 $86 $13,275 $2,670 $2,386 $67
SFY 2010 $2,581 $183 $1,922 $1,568 $207 $13,213 $6,548 $5,920 $67 $142 $95 $924 $1,591 $55 $29,469 $946 $74 $827 $2,417 $208 $64 $1,290 $1,337 $526
$1,236 $494 $118 $115 $1,546 $1,456 $37 $235 $955 $30 $2,587
$445 $1,995 $12,622 $522 $655 $1,682
$187 $593 $934
$222 $538
$236 $190
Total $3,654 $30 $183 $7,605 $2,907 $165 $319 $26,719 $13,687 $11,458 $277 $179 $37 $483 $3,170 $60 $8,080 $151 $42,091 $1,833 $74 $2,828 $5,795 $60 $237 $64 $1,572 $2,447 $715
Juneau
Billing Provider Name WALGREENS #11176 WALGREENS 01976 WALGREENS 05136 WAL-MART PHARMACY 10-1274 WAL-MART PHARMACY 10-1776 WAL-MART PHARMACY 10-3499 ZIMBRIC PHARMACY ELROY FAMILYMEDICAL CENTER
Kenosha
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Group Rural Health Clinic Physician Group GUNDERSEN CLINIC LTD Rural Health Clinic GUNDERSEN CLINIC WONEWOC Anesthetist HESS MEMORIAL HOSPITALINC Independent Lab Physician Group Pharmacy JACK A. BESANT,INC. DBA FOX PHARMACY Physician Group MILE BLUFF CLINIC Rural Health Clinic Hospital MILE BLUFF MEDICAL CENTER INC Rural Health Clinic NECEDAH FAMILY MEDICAL CENTER INC NECEDAH FAMILY MEDICALCENTER Physician Group Physician Group NEW LISBON CLINIC Rural Health Clinic Pharmacy PHILLIPS CLINIC PHARMACY Pharmacy PHILLIPS DRUG STORE INC Pharmacy RAABES PHARMACY SC Pharmacy WALGREENS 09008 Physician Group ABDUL G DURRANI MD SC Physician AFTAB A ANSARI, MD Physician Group ALLERGY & ASTHMA CLINIC OF KENOSHA Page 31 of 114
SFY 2007 $2,682 $3,058 $3,224 $2,184 $800 $133 $128 $43 $91 $2,806 $49 $193 $4,227 $111 $306 $63 $37 $659 $101 $608 $923 $1,531 $3,074
SFY 2008 $56 $3,715 $3,093 $13,553 $3,521 $122 $143 $824 $317 $4,423 $59 $785 $5,253 $57 $434 $30 $412 $1,202 $114 $841 $177 $1,517 $3,855
SFY 2009 $513 $4,838 $2,545 $23,091 $1,425 $1,387 $399 $531 $96 $319 $5,071 $76 $687 $4,378 $199 $4,963 $113 $1,220 $129 $1,118 $365 $2,683 $2,676
SFY 2010 $3,520 $4,052 $4,820 $15,308 $980 $1,690 $2,214 $557 $209 $6,736 $379 $101 $6,780 $1,864 $14,568 $552 $1,125 $352 $181 $1,981 $4,859 $95 $37 $79
Total $4,088 $15,286 $13,515 $55,176 $8,111 $3,077 $3,536 $133 $1,358 $139 $1,443 $317 $19,035 $563 $1,766 $20,638 $2,231 $20,271 $759 $449 $4,206 $695 $2,566 $1,645 $7,713 $14,465 $95 $37 $79
Billing Provider Name Billing Provider Type Physician AMTUL R AHMAD, MD Physician Group ANITA I INVEISS MD SC Physician ANITA I INVEISS, MD AURORA HEALTH CENTER KENOSHA Physician Group Hospital AURORA MEDICAL CENTER Physician Group AURORA MEDICAL GROUP Pharmacy AURORA PHARMACY INC Physician BARBARA S ROBINSON, MD Hospital CHILDRENS HOSPITAL OF Physician Group CHILDRENS MEDICAL GROUP Physician Group COMPREHENSIVE ORTHOPAEDICS Pharmacy CVS PHARMACY#08774 Pharmacy CVS PHARMACY#08777 Physician Group EAR NOSE ANDTHROAT FAMILY C Physician Group FAMILY CARE ASSOCIATES INC Physician FARAH SALAHUDDIN, MD Physician Group GENESIS MEDICAL CENTER OF KENOSHA, SC Pharmacy GOOD VALUE PHARMACY GOOD VALUE PHARMACY MEDCARE Pharmacy Nurse Practitioner GWENDOLYN M PERRY BRYE, APNP Physician Group IHC-KENOSHA RADIOLOGY, LLC Physician JAMES M BURY, MD Physician JAWAID QUDDUS, MD Physician JOHN D DECARLO, MD Physician JUNITH M THOMPSON, MD Pharmacy K MART PHARMACY 3088 Physician Group KARL B SCHEIDT MD SC Federally Qualified Health Clinic (FQHC) KENOSHA COMMUNITY HEALTH Page 32 of 114
SFY 2007
SFY 2008
SFY 2009 $36 $22 $4,766 $27,038 $798 $4,425
SFY 2010 $433 $48 $11,442 $15,827 $4,162 $6,263 $465 $106 $1,319 $554 $2,820 $196 $276 $95 $398 $557 $110 $1,399 $1,041 $48 $285 $30 $458 $3,532 $95 $13,057
Total $36 $455 $192 $30,550 $48,408 $7,380 $21,283 $480 $465 $106 $1,319 $7,533 $16,146 $196 $276 $95 $513 $3,373 $830 $8,123 $1,320 $48 $370 $87 $779 $3,935 $95 $15,986
$57 $9,522 $1,270 $1,808 $3,635 $480
$87 $4,820 $4,273 $612 $6,959
$1,788 $4,762
$4,629 $5,335
$563 $3,229
$691 $541 $1,343
$22 $1,758 $70 $3,043 $12
$94 $367 $110 $2,339 $268 $86
$57 $321 $403
$560
$522
$1,847
Billing Provider Name Billing Provider Type Family Planning Clinic KENOSHA COUNTY HEALTH DEPT Physician Group KENOSHA FAMILY PRACTICE SC KENOSHA PATHOLOGY CONSULTANTS Physician Group Physician Group KENOSHA RADIOLOGY CENTER LLC Physician Group KENOSHA UROLOGY CLINICSC Physician Group MAJED JANDALI MD SC Physician Group MIDWEST CENTER FOR WOMENS HEALTH Physician Group MIDWEST PHYS ANES SRVCS SC Pharmacy OSCO DRUG #5753 Pharmacy OSCO DRUG #5797 Physician Group PADDOCK LAKEFAMILY PRACTICE Pharmacy PICK N SAVE PHARMACY #6850 Pharmacy PICK N SAVE PHARMACY 6874 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician PRADEEP G KUMAR, MD Physician Group RODRIGO B MATA III MD SC Pharmacy SHOPKO PHARMACY NO 2031 Physician Group SURYA MEDICAL GROUP SC Pharmacy TARGET STORE T-2251 PHARMACY Physician TIMOTHY J ZELKO, DO Physician Group UHS PHYSICIAN CLINIC Hospital UNITED HOSPITAL SYSTEM INC Physician Group UNITED OCCUPATIONAL MEDICINE & WALK IN SERVICES, L Pharmacy WALGREENS #03617 Pharmacy WALGREENS #03738 Pharmacy WALGREENS #12413 Pharmacy WALGREENS 03153 Pharmacy WALGREENS 05935 Pharmacy WALGREENS 07965 Page 33 of 114
SFY 2007 $123 $117 $315
SFY 2008 $151 $866
SFY 2009 $247 $244
$93 $191 $523
$285
$36
SFY 2010 $376 $95 $2,505 $36 $280 $48 $185 $477
$115 $29 $294 $504,576 $370 $169,483
$336,144
$458
$796
$1,083 $80 $1,593 $3,225 $83,950 $494 $7,676 $6,372 $5,784 $3,777 $1,073
$5,695 $2,401 $1,572 $87 $7,929 $4,602 $6,764 $3,189 $565
$3,561 $3,381 $4,685 $112 $8,807 $3,037 $5,606 $2,094 $1,448
$252 $13 $198 $172,420 $109 $109 $1,265 $262 $79 $386 $14,572 $195,823 $2,441 $11,092 $6,349 $918 $7,101 $6,459 $3,555
Total $897 $212 $3,930 $36 $280 $48 $599 $477 $191 $523 $367 $42 $862 $1,182,623 $109 $109 $3,602 $262 $159 $11,235 $23,580 $286,030 $3,134 $35,505 $20,361 $918 $25,254 $15,520 $6,641
Kewaunee
La Crosse
Billing Provider Name Billing Provider Type SFY 2007 Pharmacy WALGREENS 09605 $5,584 Pharmacy WALGREENS#00518 $2,835 Pharmacy WAL-MART PHARMACY 10-1167 $3,626 Pharmacy AURORA PHARMACY INC $4,659 Rural Health Clinic FMC ALGOMA $439 Rural Health Clinic FMC KEWAUNEE $432 Physician Group LUXEMBURG MEDICAL CLINIC $481 Pharmacy LUXEMBURG PHARMACY LLC $2,572 Pharmacy PAMIDA PHARMACY 046 $2,689 Pharmacy CASS STREET PHARMACY $37 Pharmacy CLINIC PHARMACY OF WEST SALEM INC $1,357 Pharmacy DEGEN BERGLUND $924 Pharmacy DEGEN BERGLUND INC $307 Pharmacy DEGEN BERGLUND PHARMACY Independent Lab FRANCISCAN SKEMP HEALTHCARE $65 Pharmacy FSH HOLMEN CLINIC PHARMACY Pharmacy GUNDERSEN CLINIC LTD $1,637 Physician Group $29,419 Independent Lab GUNDERSEN LUTHERAN MEDICAL $7,085 Mental Health and Substance Abuse Services Hospital GUNDERSEN LUTHERAN MEDICAL CENTER INC $1,564 Pharmacy K MART PHARMACY 4089 $228 Physician KAREN H KEIL, MD Hospital MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE-LA $137 Physician Group MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTE $9,040 Pharmacy MCHS ONALASKA PHARMACY $379 Pharmacy MCHS SKEMP CLINIC PHARMACY $363 Page 34 of 114
SFY 2008 $4,685 $1,650 $3,533 $3,076 $334 $240 $223 $1,889 $1,545 $155 $4,068 $558
SFY 2009 $3,601 $508 $4,814 $3,453 $315 $177 $219 $178 $809 $3,178 $9,668 $1,162 $379
$3,342 $30,141 $13,288
$2,058 $31,762 $12,527
SFY 2010 $6,950 $1,082 $4,705 $3,221 $411 $400 $358 $1,462 $37 $1,833 $495 $7,724 $1,192 $29 $4,267 $1,238 $1,367 $72,181 $18,490
Total $20,820 $6,075 $16,679 $14,409 $1,499 $1,250 $1,281 $6,101 $5,080 $5,202 $1,852 $22,385 $3,221 $29 $4,710 $1,238 $8,404 $163,503 $51,390
$55 $4,699 $238 $137 $4,508 $424 $262
$55,532 $1,073 $55 $13,596 $1,931 $472 $776
$61,255 $410 $17,927 $14,063 $231 $660
$55 $123,050 $1,949 $55 $31,796 $29,542 $1,506 $2,060
Lafayette
Langlade
Billing Provider Name Billing Provider Type Pharmacy MCHS ST FRANCIS PHARMACY Dentist MICHAEL S MOSLING, DDS Family Planning Clinic OPTIONS IN REPRODUCTIVECARE Pharmacy PINNACLE PHARMACY OF LACROSS Pharmacy QUILLINS HEALTH Q PHARMACY Pharmacy QUILLINS MAJOR DRUG Pharmacy SHOPKO PHARMACY #2007 Pharmacy SHOPKO PHARMACY #2020 Pharmacy SHOPKO PHARMACY #2099 Pharmacy TARGET STORE T-0620 PHARMACY Family Planning Clinic UNIVERSITY OF WISCONSIN LA C Pharmacy WALGREENS #03498 Pharmacy WALGREENS #12455 Pharmacy WALGREENS 09214 Pharmacy WAL-MART PHARMACY 10-1679 Pharmacy WAL-MART PHARMACY 10-5127 Pharmacy WEST SALEM PHARMACY Physician Group ARGYLE CLINIC Physician Group FAMILY HEALTH OF LAFAYETTE COUNTY Hospital MEM HOSP OF LAFAYETTE COUNTY Physician Group MEMORIAL HOSPITAL OF LAFAYET Physician Group SHULLSBURG CLINIC Pharmacy WHITFORD PHARMACY INC Physician Group ASPIRUS GENERAL CLINIC Rural Health Clinic ASPIRUS GENERAL CLINICELCHO Pharmacy ELCHO PHARMACY INC Transportation FREEDOM VANS LLC Nurse Practitioner GRETCHEN L TOLSMA, NP Pharmacy LAKESIDE PHARMACY Page 35 of 114
SFY 2007 $267 $595,281 $407 $1,103 $1,163 $4,088 $2,447 $2,196 $42,481 $30,339 $10,900 $7,703 $5,688 $214 $93 $636 $157 $256 $114 $2,026 $2,324 $240 $222
SFY 2008 $208 $88 $621,070 $84 $265 $1,836 $7,509 $4,420 $6,189 $38,992 $50,171 $20,012 $8,858 $7,581 $304 $102 $156 $157 $166 $3,644 $480
SFY 2009
SFY 2010
$675,566 $32 $483 $2,646 $4,674 $9,984 $3,672 $2,633 $28,703 $59,675 $14,805 $9,645 $9,518
$915,717 $63 $1,497 $5,749 $8,848 $4,761 $3,932 $23,343 $53,803 $464 $24,684 $11,514 $13,808 $206 $341 $599 $84 $2,208 $34
$314 $694 $174 $3,331
$2,301
$323 $251 $1,785
$30 $1,992
$2,547
Total $208 $355 $2,807,634 $95 $975 $5,511 $13,423 $30,428 $15,300 $14,950 $133,519 $193,987 $464 $70,401 $37,719 $36,594 $724 $194 $1,446 $1,607 $256 $538 $11,210 $2,838 $240 $222 $323 $282 $8,626
Billing Provider Name LANGLADE HOSPITAL
Lincoln
Manitowoc
Billing Provider Type Hospital Independent Lab Physician Group LANGLADE MEMORIAL HOSP GENERAL Physician Group CLINIC ELCHO LANGLADE MEMORIAL HOSPGENERA Physician Group Physician ROBERT W CROMER, MD Physician STEVE A WEBER, DO Nurse Practitioner TOLSMA LLC Pharmacy WALGREENS 06153 Pharmacy WAL-MART PHARMACY 10-3268 Physician Group ASPIRUS MERRILL CLINIC Physician ASPIRUS WAUSAU HOSPITAL MERRILL CLINIC Group Pharmacy AURORA PHARMACY INC GOOD SAMARITAN HEALTH CENTER Independent Lab Physician Group Hospital GOOD SAMARITAN HEALTH CTR OF MERRILL WISC INC MARSHFIELD CLINIC MERRILL CENTER Independent Lab LAB Pharmacy MARSHFIELD CLINIC PHARMACY Pharmacy MERRILL HOMETOWN PHARMACY Pharmacy NORTHBAY PHARMACY INC Physician Group RADIOLOGY MERRILL SC Hospital SACRED HEARTHOSPITAL Independent Lab SACRED HEARTST MARYS HOSPIT Pharmacy STOXEN PHARMACY Pharmacy WALGREENS #10574 Pharmacy WAL-MART PHARMACY 10-1366 Physician Group AURORA HEALTH CENTER Hospital AURORA MEDICAL CENTER OF Physician Group AURORA MEDICAL GROUP INC Page 36 of 114
SFY 2007
SFY 2008 $268 $32 $1,540 $4,402
SFY 2009 $3,234 $177 $457 $3,705 $99
$96 $2,034 $66 $26 $8,077 $2,396 $418 $1,072 $135 $233 $186 $166 $2,495 $3,612
$6,709 $2,189 $808 $1,809 $118 $527 $211 $2,366 $2,549 $531
$4,706 $1,300 $380 $68 $1,432 $55 $1,817 $237 $2,873 $1,673 $2,459 $228 $5,215 $4,662 $3,936 $2,861 $1,432
SFY 2010 $23,329 $24 $1,304 $829 $7,964 $258 $244 $120 $6,761 $2,589 $480 $416 $367 $5,634 $344 $2,918 $629 $1,630 $57 $2,013 $173 $1,112 $7,088 $5,232 $4,732 $1,419 $2,145
$518 $3,018 $3,247 $3,416 $1,399
$39 $6,078 $3,957 $5,565 $290 $1,311
Total $26,830 $24 $1,514 $2,922 $18,105 $423 $270 $120 $26,253 $8,474 $1,606 $548 $4,728 $135 $773 $8,164 $958 $10,653 $629 $9,465 $57 $5,003 $173 $1,897 $21,399 $17,098 $17,649 $4,570 $6,287
Billing Provider Name Billing Provider Type Pharmacy AURORA PHARMACY INC Physician Group BELLIN HEALTH FAST CARE MANITOWOC Pharmacy COPPS FOOD CENTER PHARMACY COPPS FOOD CENTER PHARMACY #8185Pharmacy Pharmacy CVS PHARMA CY #08545 Physician DAVID A SATCHELL, MD Physician DAVID E AUGUSTINE, MD Physician Group DERMATOLOGY ASC OF WI SC Physician EKATERINA ROMAN, MD Physician EVELYN D SBAR MD, MD Physician Group EYE CLINIC OF MANITOWOC SC Physician Group FMC MANITOWOC Physician Group HFM FAMILY MEDICINE Physician Group HFM GASTROENTEROLOGY AND INTERNAL MEDICINE Physician Group HFM NEUROSCIENCE Physician Group HFM OTOLARYNGOLOGY Physician Group HFM PAIN CLINIC Physician Group HFM PEDIATRICS Pharmacy HFM PHARMACY Physician Group HFM TR HEALTH CENTER Physician Group HFM UROLOGY Physician Group HFM WOMENS HEALTH Independent Lab HOLY FAMILY MEDICAL CENTER Hospital HOLY FAMILY MEMORIAL INC Physician Group Physician JAMES J KIYAK, MD Physician JENNIFER A GARVIN CRESS, MD Physician JULIE H MARTIN, MD Physician KARL C LARSON, MD Page 37 of 114
SFY 2007 $618
SFY 2008 $1,142 $22
SFY 2009 $1,060 $20 $158 $4,375
SFY 2010 $1,926 $425 $142 $5,870
$3,218 $12 $30
$4,638
$33 $22 $86 $1,956 $1,725
$102 $43
$881
$1,981 $30
$92 $2,211 $120 $12 $388 $30 $2,845 $58 $42 $5,337 $1,669 $5,514 $873 $115
$78 $57 $2,089 $52 $5,601 $3,315 $3,571 $1,057 $57 $30 $50
$840
$2,792 $3,859 $442 $1,236 $79 $150 $87
$3,665 $307 $30 $7,125 $2,384 $16,261 $833 $166
Total $4,746 $42 $583 $142 $18,102 $12 $30 $1,016 $43 $22 $86 $92 $7,873 $150 $12 $78 $388 $87 $9,439 $365 $123 $20,855 $11,227 $25,789 $3,998 $79 $488 $117 $50
Billing Provider Name KIEL PHARMACY LAKESHORE ENDOCRINOLOGY LAKESHORE ORTHOPAEDICS LAKESHORE RADIOLOGY ASC PC MANITOWOC PHARMACIES
Marathon
Billing Provider Type Pharmacy Physician Group Physician Group Physician Group Pharmacy Ambulatory Surgical MANITOWOC SURGERY CENTER LLC Center (ASC) Physician NOLAN R HETZ, MD Physician Group ORTHOPAEDIC ASC OF MANITOWOC Pharmacy OSCO DRUG#5076 Physician Group PATHOLOGY PHYSICIANS HFM Family PLANNED PARENTHOOD OF WISCONSIN, INC Planning Clinic Physician ROBERT A GAHL, MD Physician RODNEY J HALVORSEN MD, MD Pharmacy SHOPKO PHARMACY #2003 Nurse Practitioner SUSAN F KOEHLER, APNP Physician Group THE CANCER CARE CENTER Pharmacy THE MEDICINE SHOPPE Pharmacy THE MEDICINESHOPPE Pharmacy WAL MART PHARMACY 101449 Pharmacy WALGREENS #03104 Pharmacy WALGREENS 09166 Pharmacy WOLFE PHARMACY Pharmacy 29 SUPER PHARMACY Physician Group ASPIRUS BEHAVIORAL MEDICINE CLINIC Pharmacy ASPIRUS CLINIC PHARMACY Physician Group ASPIRUS DERMATOLOGY CLINIC Physician Group ASPIRUS EDGAR CLINIC Physician Group ASPIRUS ENDOCRINOLOGY CLINIC Page 38 of 114
SFY 2007 $512
SFY 2008 $200
SFY 2009 $189 $121 $37 $1,052 $25 $123
SFY 2010 $695 $48 $174 $380
$3,952
$2,141 $724 $55
Total $1,595 $48 $295 $37 $7,524 $749 $205 $234 $1,457 $287 $357,629 $60 $319 $27,637 $546 $27 $10,988 $3,356 $24,972 $41,459 $10,115 $5,380 $4,401 $72 $9,006 $119 $281 $390
$151 $1,457 $152,644 $319 $7,336 $546 $814 $1,858 $4,126 $8,963 $1,657 $1,412 $2,175 $2,430 $37 $87
$111 $287 $59,180
$27,769 $60 $5,332
$118,036
$5,116
$9,853 $27 $5,295 $8,545 $15,315 $3,216 $1,992 $317 $24 $1,708 $52 $30 $390
$1,388 $592 $5,350 $8,429 $3,233 $1,246 $1,436 $47 $2,304
$3,491 $906 $6,951 $8,752 $2,008 $731 $472 $2,564 $30 $164
Billing Provider Name Billing Provider Type SFY 2007 ASPIRUS FAMILY HEALTH SPECIALIST Physician Group $1,010 Physician Group ASPIRUS FAMILY PHYSICIANS $368 Physician Group ASPIRUS FAMILY WALK IN $1,568 Nurse Practitioner ASPIRUS FASTCARE CLINIC Physician Group ASPIRUS FREEMAN ADULT HEALTH Physician Group ASPIRUS HOSPITALIST PROGRAM Physician Group ASPIRUS KRONENWETTER CLINIC $1,188 Physician Group ASPIRUS MARATHON CLINIC $423 Physician Group ASPIRUS OB GYN ASSOCIATES $3,967 ASPIRUS OB GYN CLINICS OUTREACH Physician Group $22 Physician Group ASPIRUS PEDIATRICS Physician Group ASPIRUS PULMONARY AND CRITICAL CARE $30 Independent Lab ASPIRUS REFERENCE LABORATORY $664 ASPIRUS REGIONAL CANCER CENTER Physician Group Physician Group ASPIRUS RHEUMATOLOGY CLINIC $78 Physician Group ASPIRUS SPECIALISTIST INC Physician Group ASPIRUS SPECIALISTS INC $47 Physician ASPIRUS SPINE & NEUROSCIENCES INSTITUTE Group Hospital ASPIRUS WAUSAU HOSPITAL $485 Physician Group ASPIRUS WAUSAU HOSPITAL FAMILY HEALTH SPECIALISTS Physician ASPIRUS WAUSAU HOSPITAL FAMILY WALK IN Group ASPIRUS WAUSAU HOSPITAL FREEMAN PhysicianHEALTH CLINI ADULT Group Physician Group ASPIRUS WAUSAU HOSPITAL INC FAMILY PHYSICIANS Physician Group ASPIRUS WAUSAU HOSPITAL INC MARATHON CLINIC Physician Group ASPIRUS WAUSAU HOSPITAL INC WESTON CLINIC Pharmacy ASPIRUS WAUSAU HOSPITAL INPA Physician Group ASPIRUS WAUSAU HOSPITAL OB GYN ASSOCIATES ASPIRUS WAUSAU HOSPITAL WESTHILLPhysician Group MEDICAL SPECIALIS Physician Group ASPIRUS WESTHILL MEDICAL SPECIALIST $47 Page 39 of 114
SFY 2008 $1,511 $428 $2,976 $36 $57 $1,320 $181 $7,927 $136 $88 $42 $770
SFY 2009 $3,307 $323 $3,657 $136 $117 $48 $3,021 $529 $8,201
SFY 2010 $1,910 $1,639 $3,162 $91 $429 $2,569 $527 $5,379
$3,736 $54 $27 $825 $16,074
$108 $7,518 $126 $30
$27
$76,329
$208
$179
$192 $10,886 $851 $1,061 $143 $320 $339 $1,018 $46 $2,975 $121 $55
Total $7,738 $2,758 $11,364 $263 $603 $48 $8,098 $1,661 $25,475 $158 $88 $181 $12,686 $126 $162 $54 $872 $192 $103,774 $851 $1,061 $143 $320 $339 $1,018 $46 $2,975 $121 $489
Billing Provider Name Billing Provider Type Physician Group ASPIRUS WESTON CLINIC Nurse Practitioner ASPIRUS WOMENS HEALTH Physician Group ASPIRUS WOMENS HEALTH OBSTETRICS Independent Lab ASSOCIATES IN PATHOLOGYSC Pharmacy AURORA PHARMACY INC Physician Group BONE AND JOINT CLINIC SC Physician Group BREAST CENTER OF CENTRAL WISCONSIN Physician BRENDA J BANASZYNSKI, MD Physician Group CARDIOVASCULAR ASSOCIATES OF Anesthetist CENTRAL WI ANESTHESIOLOGY SC Physician CHRISTOPHER J MAGIERA, MD Pharmacy COUNTY MARKET PHARMACY Physician Group EAR NOSE & THROAT ASSOC Physician EDGAR BETANCOURT, MD Physician Group EYE CLINIC OF WISCONSIN SC Family Planning Clinic FAMILY PLANNING HEALTHSERVI Physician GARY T SWEET JR, MD Physician Group GASTROINTESTINAL ASSOCIATES Physician Group HOPE CLINIC SC Independent Lab MARSHFIELD CLINIC Federally Qualified Health Clinic (FQHC) MARSHFIELD CLINIC PHARMACY Pharmacy Independent Lab MARSHFIELD CLINIC STRATFORD Independent Lab MARSHFIELD CLINIC WAUSAU Ambulatory Surgical Center (ASC) MARSHFIELD CLINIC WAUSAU AMB Physician Group MID WISCONSIN EAR NOSE & THROAT PROFESSIONALS SC Physician Group MINISTRY MEDICAL GROUP Page 40 of 114
SFY 2007 $1,771
SFY 2008 $2,089 $57 $9,223 $1,829
SFY 2009 $2,753 $115 $12,568 $1,001 $37
SFY 2010 $3,970 $282 $9,660 $520 $237
$10,577 $1,154
$28 $342 $528 $30 $1,286 $30 $2,169 $2,088 $1,231,565 $1,141,379 $1,240,988 $37 $22 $43 $875 $6,819 $63 $602 $1,447 $127 $257 $593 $61 $577 $1,815 $371 $5,217 $22 $1,885,938 $248 $171 $54 $1,739 $5,505 $1,510
$73
$42 $37 $5,692 $797 $1,447 $112
Total $10,583 $397 $57 $42,027 $4,505 $237 $37 $28 $61 $919 $30 $5,798 $401 $7,304 $22 $5,499,870 $37 $248 $192 $212 $2,651 $23,807 $63 $3,676 $3,618 $257 $832
$5,791 $766 $724
Billing Provider Name Billing Provider Type Physician Group NORTH CENTRAL WISCONSIN REHA Physician Group ORTHOPAEDIC ASSOCIATES OF WAUSAU,S.C. Physician PABLO E AMADOR, MD Pharmacy PAMIDA PHARMACY 108 Pharmacy PICK N SAVE PHARMACY #6404 Federally Qualified Health Clinic (FQHC) PRIMARY CONNECTION HEALTH CA Physician Group RADIOLOGY ASSOCIATES OF WAUSAU SC Physician RANDAL C KUMM, MD Hospital SAINT CLARESHOSPITAL OF WES Physician SALLY S MATTINGLY, MD Pharmacy SAM'S PHARMACY 10-6535 Pharmacy SHOPKO PHARMACY #2008 Pharmacy SHOPKO PHARMACY #2079 SOUTHSIDE HOMETOWN PHARMACY Pharmacy Pharmacy SOUTHSIDE PHARMACY ST CLARES HOSPITAL OF WESTON INC Physician Group Physician Group SURGICAL ASSOCIATES SC Pharmacy TARGET STORE T-0364 PHARMACY Independent Lab THE DIAGNOSTIC & TREATMENT Physician Group THE DIAGNOSTIC & TREATMENT CENTER Pharmacy TRIGS PHARMACY Physician Group UROLOGY SPECIALISTS OFWISCO Physician Group UW MEDICAL FOUNDATION Physician Group UW MEDICAL FOUNDATION INC Physician Group UW SYSTEM Pharmacy WAL MART PHARMACY 10 2813 Pharmacy WALGREENS #09609 Pharmacy WALGREENS 07009 Page 41 of 114
SFY 2007
SFY 2008 $47
SFY 2009
SFY 2010 $140 $61 $4,798 $1,414 $2,482 $394 $30 $13,419 $437 $3,304 $5,436 $45 $1,215 $127 $559 $5,745 $3,277 $587 $1,302 $128 $36
$43 $6,442
$5,324
$4,186
Total $140 $108 $43 $20,750 $1,414 $6,757 $578 $30 $17,726 $47 $468 $19,647 $30,567 $45 $7,501 $127 $648 $23,153 $12,262 $1,316 $3,607 $183 $36 $1,754 $839 $28,966 $26,003 $73,569
$773
$1,396 $106 $66 $47
$2,106 $78 $4,241 $31 $3,500 $6,090 $1,854 $89 $5,495 $3,889 $456 $544 $55
$5,468 $9,454 $1,521
$7,375 $9,588 $2,911
$5,413 $2,272 $210
$6,501 $2,825 $273 $1,552
$1,097 $408 $3,715 $5,550 $14,621
$657 $431 $6,094 $5,970 $17,626
$8,629 $4,265 $19,132
$10,527 $10,218 $22,190
Marinette
Billing Provider Name WAL-MART PHARMACY 10-2127 YOUNGS DRUG STORE INC ALEXANDER B MAMONOV, MD AURORA MEDICAL GROUP INC AURORA PHARMACY INC BAY AREA MEDICAL CENTER
Billing Provider Type Pharmacy Pharmacy Physician Physician Group Pharmacy Pharmacy Physician Group Hospital BAY AREA MEDICAL CENTER INC Independent Lab Physician Group BELLIN HEALTH FAST CARE MARINETTE Physician CALVIN D NOGLER, MD Rural Health Clinic CRIVITZ MEDICAL CLINIC Pharmacy CRIVITZ PHARMACY Physician Group DERMATOLOGY ASSOCIATESOF WI Nurse Practitioner DIANE E ROELL, NP Physician Group DR JOHN P BRIODY Rural Health Clinic FAMILY CARE MEDICAL Physician LIONEL V KURAN, MD Mental Health and Substance Abuse MARINETTE COUNTY HEALTH& HUM Services Pharmacy NORTHEAST PHARMACIES INC Physician Group NORTHERN LIGHTS CLINICSC Physician Group NORTHREACH HEALTHCARE LLC Rural Health Clinic PESHTIGO FAMILY PRACTICE Physician Group POUND COMMUNITY MEDICALCLINI Physician ROBERT E SONNENBURG, MD Pharmacy SHOPKO PHARMACY #2102 Pharmacy VALUCARE CENTER Page 42 of 114
SFY 2007 $6,263 $318 $2,523 $962 $400 $239 $857 $5,756
SFY 2008 $5,697 $756 $1,356 $568 $656 $166 $1,951 $3,153 $42 $220 $6,369
SFY 2009 $5,704 $196 $58 $2,422 $677 $893 $18,096 $4,333 $24 $47 $356 $9,720
SFY 2010 $8,836 $1,140 $5,256 $616 $623 $382 $24,433 $5,271 $394 $94 $1,249 $7,148 $275 $624 $1,260 $86
$536 $3,974 $30 $1,032 $60
$841
$547 $690
Total $26,500 $2,411 $58 $11,556 $2,823 $2,572 $786 $45,337 $18,513 $418 $183 $2,361 $27,210 $275 $30 $1,171 $3,823 $146
$1,939 $8,291 $360 $12 $6,052 $1,637
$104 $1,598 $6,136 $93
$1,979 $30 $4,614 $173 $11 $5,288 $825
$1,603 $316 $4,573 $952
$5,002 $1,446
$3,778 $165
$104 $7,119 $346 $23,614 $1,578 $11 $12 $20,121 $4,072
Marquette
Billing Provider Name VILLAGE PHARMACY INC WALGREENS 07634 WAL-MART PHARMACY 10-2545 WAUSAUKEE HEALTH CARE WAUSAUKEE MEDICAL CLINIC WISCONSIN MICHIGAN PHYSICIAN AURORA PHARMACY INC BENTLEY PHARMACIES INC BENTLEY PHARMACIES INC CHN MEDICAL CENTER MONTELLO SHAHADA G SHALASH, MD
Menominee Michigan
Billing Provider Type Pharmacy Pharmacy Pharmacy Rural Health Clinic Physician Group Physician Group Pharmacy Pharmacy Pharmacy Physician Group Physician Federally Qualified Health Clinic (FQHC) MENOMINEE TRIBAL CLINIC WOMENS PERSONAL HEALTHPROGR Family Planning Clinic Rural Health Clinic AFTER HOURS CLINIC Physician CHARLES N IKNAYAN, MD Pharmacy CVS PHARMACY#08549 Physician DANIEL J MCMAHON, MD Physician Group DCHS ORTHOPEDICS Hospital DICKINSON COMEMORIAL HOSP Physician Group DICKINSON COUNTY HEALTHCARE Physician Group DICKINSON OB/GYN CLINIC Rural Health Clinic DR HAROLD P CRISSINGER&DR Physician Group DR RAY H CAMERON Physician ELLEN E VANLAANEN, DO ESSENTIA HEALTH IRONWOOD CLINIC Physician Group Physician Group FMC IRON MOUNTAIN 115 Physician Group FMC KINGSFORD Physician Group FMC NORWAY Page 43 of 114
SFY 2007 $1,643 $5,467 $5,243 $154 $485 $602 $161 $942 $697
SFY 2008 $2,696 $4,098 $5,145 $420 $354 $553 $697 $630 $629
SFY 2009 $2,750 $7,296 $5,325 $370 $344
SFY 2010 $2,623 $5,338 $4,009 $84 $829 $96 $2,512 $624 $109 $145 $10,036 $305 $579 $55 $253 $221 $877 $42
$697 $507 $56
Total $9,711 $22,198 $19,723 $1,029 $2,012 $96 $1,155 $4,067 $2,702 $1,492 $145 $18,900 $278 $442 $22 $1,605 $103 $55 $2,456 $322 $2,341 $178 $30 $30 $105 $145 $30 $59
$2,696 $194 $26 $147 $103 $59
$2,560 $84 $30 $464
$3,609 $81 $22 $415
$224 $62
$1,919 $102 $1,402
$137 $30 $30
$105 $145 $30 $59
Billing Provider Name GRAND VIEW CLINIC GRAND VIEW HEALTH SYSTEM GRAND VIEW HOSPITAL HAROLD P CRISSINGER, MD HENKE & RYAN, P C JAMES A BATTI, MD JOHN GROENEVELD, MD JOHN M COOK, MD JOSEPH T DONOHUE, MD K MART PHARMACY #3832 K MART PHARMACY #3833 K MART PHARMACY 7031 KINGSFORD FAMILY PRACTICE CL MARQUETTE GENERAL HOSPITAL MI WI FAMILYPRACTICE ASSOC MICHELLE E DUNCAN, MD NILAR SHEIN, MD NORTHERN MENOMINEE HEALTH CE NORTHSTAR HEALTH SYSTEM OSCO DRUG#5086 PATTI L PETERSON, MD PUBLIC HEALTH DELTA & MENOMI RADIOLOGY ASC OF IRON MOUNTA RICHARD E BRUNER, DO SHOPKO PHARMACY #2011 STEPHEN C SLAJUS, DO TERENCE D RYAN, MD TERRY L STEEGE, NP
Billing Provider Type Physician Group Physician Group Hospital Physician Rural Health Clinic Physician Physician Physician Physician Pharmacy Pharmacy Pharmacy Rural Health Clinic Hospital Rural Health Clinic Physician Physician Federally Qualified Health Clinic (FQHC) Hospital Pharmacy Physician Family Planning Clinic Physician Group Physician Pharmacy Physician Physician Nurse Practitioner Page 44 of 114
SFY 2007 $2,534 $122 $11 $338 $60
SFY 2008 $1,989 $520 $87
SFY 2009 $692 $364
SFY 2010 $2,843 $191 $64 $52
$42 $636 $779 $115 $91 $73 $122 $47 $21 $1,151 $324 $50 $484 $308 $94
$128 $113 $251 $1,722 $792 $97 $117 $88
$78 $79 $210 $441 $91 $518
Total $8,057 $191 $1,071 $11 $476 $60 $206 $155 $79 $907 $3,862 $1,673 $328 $601 $986 $122 $142 $244 $22 $261 $47 $7,707 $12 $112 $1,735 $55 $111 $58
$79 $22 $261 $47 $2,129 $57 $709 $4,937 $55 $296
$165
$640 $12 $395 $55 $111
$334
$58
Milwaukee
Billing Provider Name Billing Provider Type THE DRUG STORE OF IRON MOUNTAIN Pharmacy Pharmacy THE MEDICINESHOPPE 1263 Pharmacy WALGREENS #11953 Pharmacy WALGREENS #11954 Pharmacy WAL-MART PHARMACY 10-2434 Pharmacy WAL-MART PHARMACY 10-5444 Physician M M C SUNDARAM, MD Independent Lab A2CL SERVICES LLC Physician AARON C BODNER, MD Physician ABALO NUNYAKPE, MD Independent Lab ACL SERVICESINC Physician Group ADVANCED HEALTHCARE SC Physician Group ADVANCED PAIN MANAGEMENT Physician Group AFFILIATED INFECTIOUS DISEASE CONSULTANTS OF WI Physician Group AIDS RESOURCECENTER OF Physician ALEJANDRO M VINLUAN, MD Physician ALEXANDER A ROMASHKO, MD Physician ALEXANDER T HAWKINS, MD Physician Group ALFREDO C MILLAN MD SC Physician ALFREDO C MILLAN, MD Transportation ALL NIGHT TRANSPORT INC Physician ALLEN H BABBITZ, MD Physician Group ALLERGY & ASTHMA CLINIC OF W Physician Group ALLERGY RESEARCH AND CARE SC Physician Group ALLIANCE ENTAND HEARING CEN Physician ALLISON M RING, MD Physician ALVARO ALEMAN, MD Physician ALVIN F WELLS, MD Physician AMANI A MAGUID, MD Page 45 of 114
SFY 2007 $838
SFY 2008 $1,039
SFY 2009 $998 $183 $28 $4,432 $276 $30 $55,066 $95
$2,933
$1,590
SFY 2010 $877 $177 $304 $338 $3,982 $613 $126,052
$12,582 $57 $18,849 $8,771
$30,277
$3,018 $169
$1,840 $1,249
$94 $69
$8,340 $42 $48
$55 $1,731 $22 $78 $92 $30 $1,211 $60 $56
$57
$109 $30 $55
$327 $30 $61
$36 $148 $66
Total $3,752 $177 $486 $367 $12,937 $889 $30 $223,977 $57 $95 $18,849 $11,789 $10,349 $42 $1,391 $69 $55 $30 $2,997 $60 $22 $78 $586 $30 $91 $55 $36 $148 $66
Billing Provider Name Billing Provider Type Physician Group AMERIPATH MILWAUKEE SC Physician Group ANESTHESIA ASSOCIATES OF WI RAPIDS SC Physician Group ANTHONY A FERGUSON MD SC Physician Group ARRHYTHMIA CENTER FOR Physician ARTHUR A ARENA, MD Pharmacy ASMC PHARMACY Physician Group ASPEN ORTHOPAEDIC & REHAB Pharmacy ASSISTED LIVING PHARMACY SER Physician Group ASSOCIATED OBSTETRICIANS Physician Group ASSOCIATION OF ORTHOPEDIC Physician ATHLENE A ALEXIS, MD AURORA ADVANCED HEALTHCARE I Physician Group Physician Group AURORA HEALTH CARE INC Hospital AURORA HEALTH CARE METRO INC Physician Group Physician Group AURORA HEALTH CENTER Physician Group AURORA MEDICAL GROUP AURORA MEDICAL GROUP ALTERNA Physician Group Physician AURORA MEDICAL GROUP ANESTHESIOLOGY Group Physician Group AURORA MEDICAL GROUP FRANKLI Physician Group AURORA MEDICAL GROUP INC Physician Group AURORA MEDICAL GROUP METRO AURORA MEDICAL GROUP MILWAUKEEPhysician Group Physician AURORA MEDICAL GROUP WOMENS PAVILION Group Pharmacy AURORA PHARMACY INC Audiologist AURORA SINAI MEDICAL CENTER Physician Group AURORA ST LUKES FAMILYPRACT Physician Group AURORA ST LUKES FRANKLIN Audiologist AURORA ST LUKES MEDICAL CENT Page 46 of 114
SFY 2007 $1,006
SFY 2008 $1,605 $184
SFY 2009 $516 $134
SFY 2010 $1,060 $86 $30 $803 $3,178 $44 $35 $70 $89 $56,190 $2,091 $47,983 $41,143 $974 $7,243 $494 $427 $801 $958 $1,594 $11,577 $5,797 $32,918 $3,696 $786
$829 $874
$96 $1,623
$44 $2,174
$139 $167 $158 $2,347 $409 $3,123 $8,711 $973 $332 $295 $12,918 $10,008 $354 $11,914 $1,017 $140,204 $4,286 $1,592 $329 $146 $638 $4,002 $138 $17,984 $3,913 $674 $22,540 $48 $181 $167 $157
$5,239 $436 $17,683 $343
$12
Total $4,187 $184 $220 $30 $1,772 $7,848 $44 $35 $209 $256 $158 $70,452 $3,517 $204,229 $64,149 $974 $10,162 $1,155 $427 $1,242 $1,596 $1,594 $24,731 $7,045 $91,125 $48 $4,219 $965 $157
Billing Provider Type Physician Group Hospital AURORA ST LUKES MEDICAL CTR Physician Group AURORA UW MIDWIFERY CENTER Hospital AURORA WEST ALLIS MEDICAL CE Physician Group AURORA WISELIVES CLINIC Physician Group BABBITZ BURSTEIN AND NASH Physician Group BARRY K GIMBEL MD SC Physician Group BAYLON FAMILY PHYSICIANS LTD Pharmacy BEHAVIORAL HEALTH PHARMACY Mental Health and Substance Abuse Services BEHAVIORAL HEALTH SERVICES BELLIN ANESTHESIA ASSOCIATES SC Physician Group Pharmacy BIOSCRIP PHARMACY INC Physician Group BORKOWF AND BORKOVEC MD SC Pharmacy BURLEIGH PHARMACY INC Physician Group C M M SUNDARAM MD SC Physician Group CARDIAC RHYTHM SPECIALISTS Physician Group CARDIOTHORACIC SURGERYGROUP Physician CARLOS C TAN, MD Physician CARLOS J RODRIGUEZ, MD Physician CARMEN L TERLIZZI III, MD Physician Group CAROLINA G CONTI MD SC Pharmacy CARTER DRUG STORE INC Physician Group CENTER FOR DIAGNOSTIC IMAGING Physician Group CENTER FOR NEUROLOGICAL DISORDERS Physician Group CENTER FOR PAIN MANAGEMENT Physician Group CESARZ NASSIF AND ASSOCIATES Physician CHA LEE, MD Page 47 of 114
SFY 2007 $5,483 $367 $848 $317 $77 $2,537
SFY 2008 $8,396 $893 $4,470 $87
SFY 2009 $97,722 $337 $30,350
SFY 2010 $48 $68,720 $13,633 $928 $111 $8,291 $28
Total $48 $180,321 $1,597 $49,301 $1,331 $77 $111 $20,131 $28
$5,023
$4,279
$631 $270 $245 $20 $80 $30 $48 $22 $120 $57 $1,261 $28 $154 $114 $846 $650 $274 $870 $1,044 $61 $43 $48 $22
$342
$229
$1,585 $36 $100 $2,010 $230
$164 $78 $37 $79
$681 $118
$631 $270 $1,115 $20 $1,695 $91 $91 $48 $44 $120 $171 $4,342 $303 $36 $419 $2,769 $37 $427
Billing Provider Name CHARLES A SCHMITT, MD CHILDRENS HEALTH SYSTEM CHILDRENS HOSPITAL OF WI CHILDRENS HOSPITAL OF WISCON CHILDRENS MEDICAL GROUP CHRIS T WALDO, MD CHRISTINE E KEATING, DO CHRISTINE R BRYKE, MD CITY OF MILWAUKEE HEALTH CLAY J FRANK, MD CLINIC LATINA CLINIC OF OBSTETRICS & CLINIC OF UROLOGY COLUMBIA CENTER INC COLUMBIA ST MARYS COLUMBIA ST MARYS COLUMBIA C COLUMBIA ST MARYS HOSPITAL COMMONWEALTHMEDICAL GROUP
COMMUNITY OPTIONS FOR RECOVE COMPASSIONATE DOCTORS INC COMPREHENSIVECARDIOVASCULAR CRAIG A REICH, MD CSM HOSPITAL MILWAUKEE CURTIS A CRIMMINS, MD CVS PHARMACY# 05390 CVS PHARMACY#01267 CVS PHARMACY#03394
Billing Provider Type Physician Physician Group Physician Group Hospital Physician Group Physician Physician Physician Independent Lab Physician Physician Group Physician Group Physician Group Hospital Hospital Independent Lab Hospital Physician Group Mental Health and Substance Abuse Services Physician Group Physician Group Physician Physician Group Physician Pharmacy Pharmacy Pharmacy Page 48 of 114
SFY 2007 $176 $97 $409 $22 $598
SFY 2008 $94 $2,644
SFY 2009
SFY 2010 $126 $538 $30,540
$397 $12,091
$39 $50,455 $1,133 $55 $1,112 $113 $22 $423 $389 $30,766 $170 $3,252 $4,603 $143,255 $136 $3,611 $107,408 $207 $60 $30 $48 $29,258 $55 $1,055 $177
$16,644 $237
Total $176 $317 $935 $45,683 $22 $598 $39 $48 $79,714 $55 $2,509 $137 $207 $1,535 $3,252 $8,603 $298,072 $543
$101 $55 $112 $6,923 $47 $30 $7,416 $95 $3,866 $49,615 $91 $987 $924 $1,079
$218
$383 $617
$101 $55 $142 $142 $67,821 $91 $987 $1,524 $1,696
Billing Provider Name CVS PHARMACY#08762 CVS PHARMACY#08763 CVS PHARMACY#08765 CVS PHARMACY#08766 CVS PHARMACY#08767 CVS PHARMACY#08768 CVS PHARMACY#08769 CVS PHARMACY#08770 CVS PHARMACY#08771 CVS PHARMACY#08772 CVS PHARMACY#08773 CZARINA A HELF, MD DAN FITZGERALD PHARMACY INC DANIEL H ROSLER, MD DAVID ABELSON MD SC DAVID ABELSON, MD DAVID E AMOS, MD DAVID G KAMPER, MD DAVID J SIVERHUS, MD DAVID S HASKELL, MD DAVID W OLSON, MD DEMATTIA MEDICAL GROUPLLC DENTAL ASSOCIATES FOX VALLEY DEPENDABLE CARE TRANSPORT DERMATOLOGY SERVICES SC DEVANG V GANDHI, MD DONALD J BACCUS, MD DONALD K MIDDLETON MD SC DONNA PITTER, MD
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Pharmacy Physician Physician Group Physician Physician Physician Physician Physician Physician Physician Group Dentist Transportation Physician Group Physician Physician Physician Group Physician Page 49 of 114
SFY 2007 $1,769 $1,253 $1,665 $1,006 $493 $366 $760 $44 $226 $211 $1,768 $57
SFY 2008 $2,043 $2,025 $2,356 $698 $553 $1,921 $250 $328 $2,324 $56
SFY 2009 $289 $2,965 $537 $1,566 $475 $31 $4,760 $128 $1,924 $359 $4,601 $28
SFY 2010 $1,020 $4,739 $405 $1,199 $3,094 $5,341 $814 $1,183 $265 $2,479 $431 $143
$1,771 $47 $60
$36 $47 $512 $334 $55 $30 $78 $141 $174 $464 $61
$712 $75
$1,537 $81 $94 $82 $111
$36 $22 $67
$39
Total $5,122 $10,982 $2,201 $5,333 $2,865 $4,044 $12,782 $1,236 $3,661 $835 $11,172 $57 $515 $143 $1,807 $512 $506 $60 $196 $174 $494 $61 $2,248 $75 $81 $130 $82 $133 $106
Billing Provider Name DRS KHAN & ALMAS EDITH A MCFADDEN, MD EDWARD J ROSENTHAL, MD EMERGENCY MEDICINE SPECIALISTS EMMANUEL S MANUEL MD, MD ENT ASSOCIATES SC ENT SPECIALISTS OF MILWAUKEE EPILEPSY & SEIZURE CARE SPEC ERMED SC EVAN K SAUNDERS MD SC EYE CARE SPECIALISTS SC FAMILY DOCTORS SC FAMILY MEDICINE ASSOCIA FAMILY PRACTICE CLINICOF MAY FROEDTERT CLINIC PHARMACY FROEDTERT HOSP OUTPAT PHARMA FROEDTERT HOSPITAL GARY S HAUKE, MD GEOFFREY NKWAZI, MD GEORGE V CHANDY, MD GERALD L IGNACE INDIAN GI ASSOCIATES LLC GOKAY CARE TRANSPORT GOODS TRANSPORTATION INC GORAN T RUDIC MD SC GOUHAR Y KHAN, MD GREAT LAKES GREAT LAKES NEUROSURGICAL
Billing Provider Type Physician Group Physician Physician Physician Group Physician Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Physician Group Pharmacy Pharmacy Hospital Physician Physician Physician Federally Qualified Health Clinic (FQHC) Physician Group Transportation Transportation Physician Group Physician Physician Group Physician Group Page 50 of 114
SFY 2007 $4,217
SFY 2008 $2,361 $58
SFY 2009 $5,405 $30 $48
SFY 2010 $7,513 $139 $48 $272 $48 $55 $278
$10
$31 $228 $47 $55 $87 $16 $13,579 $12 $11,524 $43 $242,748 $267 $114 $72 $30 $22 $65 $136 $5,563 $47 $72 $3,418 $1,212 $7,763 $1,175 $14,660 $364 $585 $794 $23 $43 $192,992 $751 $281 $94 $909 $2,511 $47 $516 $30 $1,109 $209
Total $19,496 $169 $154 $272 $48 $10 $55 $278 $31 $275 $1,727 $239 $87 $794 $51 $86 $460,843 $751 $547 $207 $1,375 $3,096 $22 $65 $208 $2,387 $31,404 $47
Billing Provider Name Billing Provider Type Physician GREATER MILWAUKEE OTOLARYNGOLOGY LLCGroup Physician Group GREATER MILWAUKEE PLASTIC SU Physician Group GREATER MILWAUKEE SURGICAL Physician HAKJOONG KIM, MD Physician HAROLD K RICHES, DO Federally Qualified Health Clinic (FQHC) HEALTH CARE FOR THE HOMELESS Physician Group HEART & VASCULAR SPECIALISTS Physician Group HEART CARE ASSOC Physician Group HISPANIC MEDICAL CENTER Physician Group HLS MEDICAL SERVICES SC Physician Group HYPERBARIC & WOUND CARE ASSOCIATES Physician INFECTIOUS DISEASE SPECIALISTS OF SE WI SC Group Physician Group INNOVATIVE PAIN CARE LLC Pharmacy ISAAC COGGS HERITAGE HEALTH Physician JAMES ETHINGTON, MD Physician JAMES H BARNETT, MD Physician JAMES H LANGENKAMP, MD Physician JANINE JAMES, MD Physician JAVIER A RINCON, MD Physician Group JAWAD H KHAN MD SC Physician JEFFREY J ANDEREGG, MD Physician JEREMIAS B VINLUAN, MD Pharmacy JEWEL OSCO 3618 Physician JOCELYN K EICHE, MD Physician JOHN A ALBERT, MD Physician JOHN C ROGERS, MD Physician JOHN D SUSON, MD Physician Group JOHN E DANIELS MD SC Page 51 of 114
SFY 2007 $78
SFY 2008
SFY 2009 $61 $30 $48 $91
SFY 2010 $444
$143
Total $505 $78 $30 $191 $91 $5,334 $30 $120 $145 $3,753 $71 $61 $55 $4,112 $58 $99 $87 $214 $30 $454 $176 $4,980 $475 $57 $207 $912 $37 $22
$912 $120 $407
$297
$2,000 $30
$2,125
$491
$1,528
$1,535 $58
$145 $1,328 $71 $61 $55 $2,578 $99
$167
$87 $48 $95 $30 $359 $1,733
$176 $1,019 $475 $57
$1,547
$682
$51 $47 $37
$93 $30
$63 $835 $22
Billing Provider Name JOHN J BRENNAN, MD JOSELITO A BAYLON, MD JOSEPH P HERZOG, MD JOSEPH S KOSTRZEWSKI DO SC JOSEPH S KOSTRZEWSKI, DO K MART PHARMACY 4395 K MART PHARMACY 3182 K MART PHARMACY 3618 K MART PHARMACY 4380 K MART PHARMACY 4385 KAREN S WATSON, MD KARIM BAKHTIAR MD SC KATHLEEN M TREBIAN, MD KATZOFF RIHAWI SC KENNETH D DEMBNY, MD KENNETH S SCHER, MD KEVIN A WEIDMAN, MD KHAN MEDICAL ASSOCIATES SC KHIZZAR SHAUKAT, MD KIM A HANSEN, MD KUMAR V IYER, DDS KURT R OELKE, MD LAABS INC LABOTTS PHARMACY LAKESHORE MEDICAL CLINIC LATHA RAJA SHANKAR, MD LAWRENCE A STERKIN, MD LAYTON AVENUE DERMATOLOGY LEE MEDICAL CLINIC SC
Billing Provider Type Physician Physician Physician Physician Group Physician Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Physician Group Physician Physician Group Physician Physician Physician Physician Group Physician Physician Dentist Physician Pharmacy Pharmacy Physician Group Physician Physician Physician Group Physician Group Page 52 of 114
SFY 2007 $130
SFY 2008 $243
SFY 2009
SFY 2010 $48 $100 $306 $429 $338 $1,737 $31 $358 $745 $58 $450 $55 $411 $1,130 $55
$73 $13 $132 $13 $131
$54 $57 $57 $47
$30 $108 $455 $87
$30 $57 $640 $172 $141 $46 $5,370
$47
$22 $12 $4,147 $22 $177
$105 $23,251 $79 $689 $58
$2,397
Total $373 $48 $100 $306 $502 $351 $132 $1,737 $44 $543 $57 $745 $114 $528 $55 $108 $896 $1,217 $57 $55 $640 $240 $259 $46 $35,166 $22 $79 $866 $58
Billing Provider Name Billing Provider Type Physician LEONARDO APONTE, MD Physician LEWIS CHAMOY, MD Physician Group LINCOLN HEALTH CENTER Physician Group LUCINDA K FENSKE MD SC Physician LUCINDA K FENSKE, MD Physician LUTFI T TOMBULOGLU, MD Physician LUZ STELL MORENO, MD Physician Group M R SETHI MDSC Physician MADHAVI A PAREKH, MD Physician Group MADISON MEDICAL AFFILIATES Physician MALA THENAPPAN, MD Physician MAQBOOL ARSHAD, MD Physician MAQSOOD AHMAD, MD Physician MARK E HODGSON, MD Nurse Practitioner MARNI K HEBERT, NP MARQUETTE NEIGHBORHOOD HEALTH Nurse Practitioner CENTER Physician MARTIN E SAMUEL, MD Physician MARVIN E SATTLER, MD Physician MASROOR MUNIM, MD Physician MATTHEW B LEE, MD Physician MAURICIO TOVAR, MD Physician Group MCMC RADIOLOGY LLC Physician Group MCMC URGICARE LLC Mental Health and Substance Abuse MCW DEPARTMENT OF PSYCHIATRY Services Physician Group MEDICAL CONSULTANTS Physician Group MEDICAL DIAGNOSTIC IMAGING Physician Group MEDICAL MANAGEMENT ASSO Page 53 of 114
SFY 2007
SFY 2008
SFY 2009 $97 $55 $905
SFY 2010
Total $97 $55 $1,125 $466 $30 $1,865 $477 $3,984 $109 $4,233 $55 $91 $210 $171 $273 $6,292 $109 $61 $235 $98 $686 $175 $2,790
$219 $466 $1,487 $421 $2,866 $3,918 $61 $171 $88 $4,150 $109 $235
$30 $378 $57 $461 $22 $91 $657 $192 $30 $90 $186 $1,408 $61 $98 $109 $449 $219
$87 $34 $55 $60
$60
$36
$697
$30 $36 $877
$546 $140 $1,244
$808
$368
$48 $36 $152
$336 $347 $1,358
$336 $394 $36 $2,686
Billing Provider Name Billing Provider Type Physician Group MEDPOINT FAMILY CARE CENTER Pharmacy MEDPOINT PHARMACY INC Physician Group METRO NEUROSURGICAL SC Physician Group METROPOLITAN ANESTHESIOLOGISTS SC Physician MICHAEL A DIDION, DO Physician Group MICHAEL H GILMAN DO SC Physician MICHAEL J HAFRAN, MD Physician MICHAEL J KUHN JR, MD Physician MICHAEL N KATZOFF, MD Physician Group MIDWEST ANESTHESIA CONSULTAN Physician Group MIDWEST AREA PHYSICIANS LLC Physician Group MIDWEST COMPREHENSIVE PAIN MIDWEST NEPHROLOGY ASSOCIATES Physician Group Hospital MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL,LLC Physician Group MIDWEST URGENT MEDICALSERVIC Physician Group MILWAUKEE CARDIAC CARE LLC Physician Group MILWAUKEE CLINIC OF ORTHOPEDIC SURG Institution for Mental Disease MILWAUKEE COBEHAVIORAL Optometrist MILWAUKEE EYECARE ASSOCIATES Federally Qualified Health Clinic (FQHC) MILWAUKEE HEALTH SERVICES Physician Group Physician Group MILWAUKEE IMMEDIATE CARE CENTER Physician MILWAUKEE INTERNAL MEDICINE ASSOC INC Group Independent Lab MILWAUKEE MIDWEST MED BLDG Physician Group MILWAUKEE NEPHROLOGISTS SC Physician Group MILWAUKEE NEUROLOGICALINSTIT Physician Group MILWAUKEE ORTHOPEDIC SPECIAL Page 54 of 114
SFY 2007 $751
SFY 2008 $171
SFY 2009 $3,673 $111
SFY 2010 $2,062 $256 $348 $295
$211 $469
$469 $30 $252 $47 $55 $97 $398 $195 $242 $203 $1,086 $79 $687 $3,430 $154 $242
$47
$30 $3,247
$22 $464 $1,220 $141 $75,164 $655 $264 $653 $286
Total $6,658 $367 $348 $295 $211 $938 $30 $252 $47 $259 $1,086 $176 $1,132 $3,430 $350 $485 $52 $4,931 $141 $120,798 $3,106 $1,785 $264 $2,356 $381 $61 $78
$7,888 $804 $1,014 $245
$6,313 $1,796
$31,433 $506 $117 $708 $95 $61 $78
$750
Billing Provider Name Billing Provider Type Physician Group MILWAUKEE PAIN TREATMENT SER Physician Group MILWAUKEE RADIOLOGISTS LTD SC Pharmacy MLK HERITAGEHEALTH CENTER Physician MOHAMMAD E RASSOULI, MD Physician MOHAMMED R SETHI, MD Physician MUHAMMAD Y KHAN, MD Physician NEAL H POLLACK, DO Physician NEBOJSA R STEVANOVIC, MD Physician NEURODIAGNOSTIC CLINIC OF MILWAUKEE SC Group Physician Group NEUROLOGY ALLIANCE SC Physician NEUROLOGY NEURODIAGNOSTIC CENTER SC Group Pharmacy NEWPORT PHARMACY Physician Group NOEMI A PRIETO MD SC Physician NORMAN D BUEBENDORF, MD Physician NORTH AVENUE FAMILY MEDICAL CENTER LLC Group Physician Group NORTH SHORE ORTHOPAEDICS SC Physician Group NORTH SHORE PATHOLOGISTS Physician Group NORTH SHORE UROLOGY SC Physician Group NORTHEAST OB GYN SC Physician Group NOVA MEDICAL CENTER LLC Physician Group OAK CREEK URGENT CARE LLC Physician Group OAKWOOD FAMILY MEDICAL CLINIC SC Physician OLUSOJI OYESANYA, MD Physician Group OMNI FAMILY MEDICAL CLINIC Physician Group ONCOLOGY ALLIANCE SC Physician Group OPHTHALMOLOGY ASSOCIATES SC Physician Group OPTHALMOLOGYASSOCIATES SC Physician Group ORTHOPAEDIC ASSOCIATES OF MILWAUKEE, S.C. Hospital ORTHOPAEDIC HOSPITAL OF WISCONSIN Page 55 of 114
SFY 2007
SFY 2008 $257
SFY 2009 $1,241 $3,678 $52
SFY 2010 $791 $1,598 $8,823 $48 $48 $714
$94 $30 $77
$30 $166
$242 $30
$106 $150 $37
$118
$197
$1,104
$20
$78 $47
$48 $473 $48 $2,468 $113
$255
$538
$55
$22 $283
$5,313
$108 $270 $101 $75 $342 $67 $634 $48 $2,196 $22 $93 $469 $847 $114 $971 $7,652 $483 $170 $116 $136 $6,753
Total $791 $3,097 $12,502 $100 $94 $108 $714 $244 $108 $270 $101 $422 $522 $104 $634 $48 $3,614 $22 $93 $595 $1,387 $162 $971 $10,912 $596 $170 $116 $212 $12,349
Billing Provider Name Billing Provider Type Physician Group ORTHOPEDIC SURGEONS OFWISCO Pharmacy OSCO DRUG #3604 Pharmacy OSCO DRUG #3608 Pharmacy OSCO DRUG #3642 Pharmacy OSCO DRUG #3645 Pharmacy OSCO DRUG #3648 Pharmacy OSCO DRUG #3653 Pharmacy OSCO DRUG #5704 Pharmacy OSCO DRUG #5714 Pharmacy OSCO DRUG #5717 Pharmacy OSCO DRUG #5718 Pharmacy OSCO DRUG #5719 Pharmacy OSCO DRUG #5741 Pharmacy OSCO DRUG #5743 Pharmacy OSCO DRUG#5701 Pharmacy OSCO DRUG#5706 Pharmacy OSCO DRUG#5732 Physician Group PAIN MANAGEMENT & TREATMENT Physician PAIN MANAGEMENT CENTER OF WISCONSIN,S.C.Group Physician PAUL D BURSTEIN, MD Physician Group PEDIATRIC & ADULT MEDICINE Physician Group PEDIATRIC DIAGNOSTIC IMAGING PEDIATRIC DIAGNOSTIC IMAGING SC Physician Group Physician Group PEDIATRIC RADIOLOGIC SERVICE Physician PERO G KOMOZEC, MD Transportation PHASE II ENTERPRISES Pharmacy PICK N SAVE PHARMACY #6348 Pharmacy PICK N SAVE PHARMACY #6366 Pharmacy PICK N SAVE PHARMACY #6416 Page 56 of 114
SFY 2007 $30 $489 $98 $453 $389 $42 $285 $434 $281 $608 $65 $68 $100 $394 $672 $78 $25
SFY 2008
SFY 2009 $472
SFY 2010 $1,554
$746 $199 $79 $412 $88 $237 $36 $36 $25
$523 $255 $845 $36
$49 $36 $22 $89
$34
$3,956 $135 $193
Total $2,056 $489 $98 $453 $389 $42 $285 $434 $281 $608 $65 $68 $100 $394 $672 $78 $25 $1,269 $454 $79 $1,582 $36 $72 $74 $36 $22 $3,956 $257 $193
Billing Provider Name Billing Provider Type Pharmacy PICK N SAVE PHARMACY #6846 Pharmacy PICK N SAVE PHARMACY #6847 Pharmacy PICK N SAVE PHARMACY #6857 Pharmacy PICK N SAVE PHARMACY #6862 Pharmacy PICK N SAVE PHARMACY #6864 Pharmacy PICK N SAVE PHARMACY #6873 Pharmacy PICK N SAVE PHARMACY #6878 Pharmacy PICK N SAVE PHARMACY #6879 Pharmacy PICK N SAVE PHARMACY #6880 Pharmacy PICK N SAVE PHARMACY #6882 Pharmacy PICK N SAVE PHARMACY #6883 Pharmacy PICK N SAVE PHARMACY #6885 Pharmacy PICK N SAVE PHARMACY 6371 Pharmacy PICK N SAVE PHARMACY 6387 Physician Group PLANK ROAD RADIOLOGY Family Planning Clinic PLANNED PARENTHOOD OF WI Family Planning Clinic PLANNED PARENTHOOD OF WISC Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Pharmacy PRESCRIPTIONS PLUS GOOD VALU Physician PRIMO R TAMAYO, MD Physician Group PROCARE MEDICAL GROUP Federally Qualified Health Clinic (FQHC) PROGRESSIVE COMMUNITY HEALTH CENTERS Physician Group PULMONARY & CRITICAL CARE PULMONARY MEDICINE CONSULTAN Physician Group Physician RACHAEL L WEIDERHOLD, DO Physician Group RADIOLOGY ASSOCIATES OF MILW Physician Group RADIOLOGY SPECIALISTS OF Physician RAJASHRI S MANOLI, MD Page 57 of 114
SFY 2007
SFY 2008
SFY 2009
$167 $209 $140 $33 $29 $244 $999
$813 $206 $1,448 $149 $1,060 $920
$1,468,879
$1,039,266 $229
$1,203 $123 $1,795 $81 $222 $1,330 $353 $47 $64,865 $513,652 $219,308
SFY 2010 $211 $2,917 $1,321 $461 $1,189 $451 $854 $418 $1,661 $1,015 $17 $675 $629 $158 $47 $244,258 $151,378 $182,115 $278 $31,859 $13,768 $30 $101 $58 $95 $830 $714
$47 $5,615 $882
$5,576 $2,646
$11,321 $7,659
Total $211 $2,917 $1,321 $461 $1,189 $451 $854 $2,601 $2,200 $4,399 $131 $1,076 $3,263 $2,430 $94 $309,123 $3,173,176 $401,423 $507 $47 $54,371 $24,955 $30 $101 $88 $638 $1,335 $1,159
$30 $35 $71 $78 $509 $434 $366
Billing Provider Name RAM K MITTAL, MD RAMON A AGOR, MD RAVI GUPTA, MD RAYMOND W MOY MD SC RENEE SINOPOLI, MD RETINA & VITREOUS CONSULTANT RHEUMATIC DISEASE RICARDO R SINENSE, MD RICHARD A STELIGA, MD RICHARD D DAVENPORT MDAND AS RICHARD N EVANS JR, MD RISING PHOENIX HEART INSTITU RIVERBEND SERV U PHARMACY RIZWANULLAH ARAIN, MD ROBERT J FRITZ, MD ROESCHENS OMNICARE PHARMACY ROSEANN GUMINA, MD SAMI A ROUMANI, MD SAMIR MULLICK MD SC SAM'S PHARMACY 10-6303 SAM'S PHARMACY 10-6324 SAM'S PHARMACY 10-8167 SARBJEET S SANDHU, MD SEAN P KEANE, MD SETON PHARMACY SHAFI MEDICAL CENTER SC SHAHIDA R MUNIM, MD SHEEBA A PANNU, MD SHOREVIEW PEDIATRICS SC
Billing Provider Type Physician Physician Physician Physician Group Physician Physician Group Physician Group Physician Physician Physician Group Physician Physician Group Pharmacy Physician Physician Pharmacy Physician Physician Physician Group Pharmacy Pharmacy Pharmacy Physician Physician Pharmacy Physician Group Physician Physician Physician Group Page 58 of 114
SFY 2007
SFY 2008
SFY 2009 $183
SFY 2010 $101 $89 $86 $55
$42 $48 $11 $55 $55 $242 $79 $101 $95 $676 $100 $30 $1,225 $946 $873 $264 $309 $193 $399 $11,419 $252 $59
$109 $93 $1,483 $526
$290
$480
$191
$363 $592
$303 $468 $338 $132
$36 $90 $93 $10,771
$82 $37 $9,983
$173 $356 $7,724 $58
Total $101 $272 $86 $55 $42 $48 $11 $55 $55 $242 $189 $101 $93 $1,579 $1,972 $100 $30 $1,528 $1,967 $1,803 $264 $442 $229 $345 $884 $39,896 $252 $58 $59
Billing Provider Name SIDNEY HERSZENSON, MD
Billing Provider Type Physician Federally Qualified Health Clinic (FQHC) SIXTEENTH STREET COMMUNITY Federally Qualified Health Clinic SIXTEENTH STREET COMMUNITY HEALTH CENTER (FQHC) Pharmacy SKYWALK PHARMACY Physician Group SOUTHEAST SURGICAL SC SOUTHEASTERN WI ANESTHESIOLOGY Physician Group Physician Group SOUTHEASTERNWI INFECTIOUS Physician Group SOUTHSIDE PEDIATRIC ASSOCIAT Physician Group SPORTS MEDICINE AND ORTHOPED Physician SRINIVAS R BRAMHADEVI, MD Physician Group ST MARYS HOSPITAL OZAUKEE Physician STEPHEN C HINKLE, MD Physician STEPHEN T BAKER, MD Physician STEVEN B GREENMAN, MD Physician STEVEN H GOLDBERG, MD Physician SUHAS K SHELGIKAR, MD Physician Group SUMMIT ANESTHESIOLOGY LTD Physician SUSAN J RIEGG, MD Physician Group SUSON EYE SPECIALISTS MD SC Pharmacy SWAN SERV U PHARMACY Physician SYED N HASNAIN, MD Physician Group TAHA MEDICAL CENTER SC Nurse Practitioner TAKE CARE HEALTH WISCONSIN SC Pharmacy TARGET STORE T-0223 PHARMACY Pharmacy TARGET STORE T-1895 PHARMACY Pharmacy TARGET STORE T-1925 PHARMACY Pharmacy TARGET STORE T-2199 PHARMACY Page 59 of 114
SFY 2007
SFY 2008
SFY 2009
SFY 2010 $152 $6,616 $5,303 $15 $61 $48 $30 $289 $12,049
Total $152 $17,392 $13,362 $15 $91 $47 $48 $550 $289 $1,727 $12,049 $48 $109 $672 $55 $30 $501 $22 $256 $1,885 $799 $412 $1,455 $10,806 $13,409 $5,127 $3,006
$2,616
$1,999
$6,161 $8,059 $30
$47 $206 $171 $237 $1,395 $78 $161 $48 $109 $101 $30 $326 $22 $132 $467 $1,056 $114 $256 $697 $219 $412 $1,455 $4,936 $8,079 $2,980 $1,545
$571 $55
$176
$296 $875 $344 $731
$2,252 $1,793 $482 $416
$3,322 $2,662 $1,321 $314
Billing Provider Name Billing Provider Type Pharmacy TARGET STORE T-2388 PHARMACY Pharmacy TARGET STORE T-2586 PHARMACY Pharmacy TARGET T-0024 PHARMACY Pharmacy TARGET T-0057 PHARMACY Family Planning Clinic THE BOARD OFREGENTS OF THE THE MEDICAL COLLEGE OF WISCONSIN Physician Group INC Family Planning Clinic THE MEDICAL COLLEGE OFWI IN Family Planning Clinic THE MEDICAL COLLEGE OFWISCO Pharmacy THE PHARMACYSHOPPE Physician Group THE SLEEP WELLNESS INSTITUTE Physician THERESA PARDOE, DO Physician THOMAS SLOTA, MD Pharmacy THOMPSON'S SERV-U PHARMACY THULASIRAMA P RAVICHANDRAN, MD Physician Transportation TNT TRANSIT, Physician TODD J POREMSKI, MD Physician TODD W BURNER, MD Pharmacy TOSA PHARMACY Physician TRINH TRUONG, MD Pharmacy UNION SERV U PHARMACY Independent Lab UNITED DYNACARE LLC Physician Group UNITED OCCUPATIONAL MEDICINE & WALK IN SERVICES, L Physician URSULA STAR ADAMCZYK, MD Physician Group UWM SILVER SPRING NURSING CTR Physician Group VILLARD PRIMARY & SPECIALTY Physician Group VINCENT G LUBSEY MD SC Physician VIOLETA A SINGSON, MD Physician WALEED S NAJEEB, MD Pharmacy WALGREENS #00016 Page 60 of 114
SFY 2007 $47 $523 $61 $645 $48,127 $1,941 $947
SFY 2008 $460 $191 $100 $1,929 $35,357 $1,078 $230
SFY 2009
$123 $53 $1,907 $47,587 $786 $709 $61 $52 $48 $936 $101
SFY 2010 $81 $645 $743 $966 $4,971 $87,727 $1,301 $29 $145 $408 $48 $605
Total $81 $1,152 $1,581 $1,180 $9,452 $218,799 $5,106 $1,915 $145 $469 $52 $95 $1,541 $148 $800 $135 $178 $170 $269 $44 $501,487 $108 $88 $172 $14,713 $17,814 $68 $22 $18,362
$47 $800 $135
$178 $170 $269 $73,188 $44 $77,407 $155,499 $108 $88 $1,949 $11,119 $195,393
$4,256 $1,311 $22 $1,900
$3,132 $478 $68 $3,518
$172 $5,377 $4,906
$5,966
$6,977
Billing Provider Name WALGREENS #00295 WALGREENS #01460 WALGREENS #02296 WALGREENS #02380 WALGREENS #03125 WALGREENS #03578 WALGREENS #03616 WALGREENS #04253 WALGREENS #04537 WALGREENS #06058 WALGREENS #07809 WALGREENS #09066 WALGREENS #09549 WALGREENS #10196 WALGREENS #10873 WALGREENS #10963 WALGREENS #11237 WALGREENS #12524 WALGREENS #12783 WALGREENS 01942 WALGREENS 02911 WALGREENS 02925 WALGREENS 03109 WALGREENS 03394 WALGREENS 03509 WALGREENS 03666 WALGREENS 03732 WALGREENS 04095 WALGREENS 04254
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Page 61 of 114
SFY 2007 $3,799 $859 $3,640 $1,663 $701 $3,399 $3,795 $2,201 $12,099 $5,516 $1,104 $994 $898 $1,139 $3,688
SFY 2008 $3,314 $242 $3,250 $1,384 $596 $1,741 $2,411 $2,542 $14,879 $5,529 $2,950 $896 $1,355 $2,775 $5,736 $28
SFY 2009 $3,856 $998 $3,997 $1,820 $4,507 $1,869 $4,188 $14,911 $9,735 $4,765 $2,342 $3,629 $2,744 $10,578 $1,336 $793 $927 $7,600 $1,359 $2,567 $5,792 $3,342 $3,763 $2,603 $1,373 $1,774 $2,041 $2,144
SFY 2010 $6,862 $3,824 $11,472 $1,101 $12,542 $6,314 $3,988 $27,482 $11,708 $7,144 $6,324 $6,491 $4,581 $15,271 $4,915 $4,022 $4,442 $9,371 $2,778 $6,373 $8,441 $7,058 $4,886 $5,113 $3,746 $5,884 $4,268 $4,030
$3,692 $319 $799 $3,049 $2,375 $716 $1,513 $167 $1,029 $1,131 $3,852
$3,864 $1,202 $2,439 $2,945 $1,310 $1,472 $203 $1,195 $896 $1,147 $4,157
Total $17,831 $5,923 $22,359 $3,046 $4,217 $22,188 $14,389 $12,920 $69,370 $32,488 $15,962 $10,556 $12,372 $11,239 $35,274 $6,252 $4,842 $5,369 $24,528 $5,658 $12,177 $20,228 $14,085 $10,837 $9,432 $6,481 $9,583 $8,587 $14,183
Billing Provider Name WALGREENS 04350 WALGREENS 04471 WALGREENS 04556 WALGREENS 04720 WALGREENS 04774 WALGREENS 04827 WALGREENS 04984 WALGREENS 05231 WALGREENS 05459 WALGREENS 05601 WALGREENS 05884 WALGREENS 06020 WALGREENS 07661 WALGREENS 09839 WALGREENS#00649 WALGREENS#00665 WALGREENS#01200 WALGREENS#01336 WALGREENS#03813 WALGREENS#03882 WALGREENS#04887 WALGREENS#07370 WALGREENS#07568 WALGREENS01652 WALGREENS01685 WALGREENS01979 WALGREENS02182 WALMART PHARMACY WAL-MART PHARMACY 10-1394
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Page 62 of 114
SFY 2007 $3,711 $1,557 $346 $5,730 $1,572 $46 $1,827 $1,501 $663 $1,061 $799 $3,083 $195 $179 $1,819 $2,535 $1,371 $3,982 $9,942 $1,513 $2,623 $4,717 $747 $2,028 $6,009 $1,406 $2,312 $3,758
SFY 2008 $2,505 $382 $119 $3,871 $1,316 $157 $1,632 $1,516 $1,116 $2,819 $518 $2,247 $506 $739 $1,674 $2,893 $1,210 $2,603 $9,485 $2,924 $1,419 $5,681 $2,671 $1,433 $8,253 $2,941 $2,861 $1,244
SFY 2009 $5,412 $1,624 $268 $4,735 $1,236 $997 $3,788 $999 $576 $3,138 $1,727 $2,430 $1,016 $1,540 $1,717 $5,270 $2,330 $3,605 $17,618 $3,085 $3,000 $7,710 $2,372 $2,783 $9,343 $3,106 $2,414 $1,999
SFY 2010 $6,781 $3,677 $1,417 $8,845 $6,813 $2,007 $5,022 $1,652 $2,317 $6,185 $954 $5,083 $1,477 $3,125 $5,796 $5,669 $1,799 $2,232 $23,916 $7,141 $5,526 $13,505 $2,651 $5,399 $23,231 $5,413 $7,860 $2,635
Total $18,409 $7,241 $2,150 $23,182 $10,937 $3,208 $12,270 $5,667 $4,672 $13,203 $3,998 $12,842 $3,194 $5,583 $11,006 $16,368 $6,710 $12,422 $60,961 $14,663 $12,568 $31,613 $8,440 $11,643 $46,835 $1,406 $13,772 $16,892 $5,877
Minnesota
Billing Provider Name Billing Provider Type Pharmacy WAL-MART PHARMACY 10-1551 Pharmacy WAL-MART PHARMACY 10-2828 Pharmacy WAL-MART PHARMACY 10-2936 Pharmacy WAL-MART PHARMACY 10-3496 Physician WALTER A FUHR, MD Physician WALTER BRUMMUND, MD Physician WALTER I MELNYCZENKO, MD Physician WALTER K T WONG, MD WATERTOWER PAIN CONSULTANTS SC Physician Group Physician Group WAUWATOSA CHILDRENS CLINIC Physician Group WEST ALLIS ORTHOPEDIC CLINIC WHEATON FRANCISCAN HEALTHCARE Hospital FRANKLIN, INC. Hospital WHEATON FRANCISCAN HEALTHCARE ST FRANCIS INC WHEATON FRANCISCAN HELATHCAR Hospital Hospital WHEATON FRANCISCAN INC - ST JOSEPH WHEATON FRANCISCAN LABORATOR Independent Lab Physician Group WHEATON FRANCISCAN MEDICAL WHEATON FRANCISCAN PHARMACY Pharmacy Hospital WHEATON FRANCISCAN-THE WISCONSIN HEART HOSPITAL Pharmacy WILKES VILLAGE PHARMACY Physician WILLIAM T MCCULLOUGH, MD Physician Group WISCONSIN AVE MED CLINIC SC Physician Group WISCONSIN BONE & JOINTSC WISCONSIN NEUROLOGY CLINIC LLC Physician Group Ambulatory Surgical Center (ASC) WISCONSIN SURGERY CENTER LLC Physician Group WOMENS CARE CENTER S C ABBOTT NORTHWESTERN HOSPITAL Hospital Physician Group ALLINA MEDICAL CLINIC Page 63 of 114
SFY 2007 $413 $47 $77 $195
SFY 2008 $215 $146 $477 $937
$47
$77
SFY 2009 $378 $531 $1,683 $1,769 $58 $109 $279
SFY 2010 $928 $738 $2,537 $4,505 $30 $568 $286 $78 $91 $22,945 $83,057 $225,692 $22,065 $116,034 $627 $2,057 $13 $30 $412 $375
$376 $145 $2,909 $4,283 $7,807 $537
$786 $10,678 $527 $29,467 $1,048
$44 $1,405 $52,513 $30,887 $173,217 $4,278 $45,069 $530 $2,540 $13
$110
$183
$243 $780
Total $1,935 $1,463 $4,775 $7,406 $58 $140 $971 $286 $78 $91 $44 $24,351 $136,731 $31,031 $412,495 $31,153 $198,378 $2,741 $4,597 $26 $30 $412 $910 $780 $1,447 $555 $327 $1,217
$1,447 $259
$295 $262 $503 $65 $715
Billing Provider Name Billing Provider Type Physician Group ALLINA MEDICAL CLINIC HASTIN Nurse Practitioner BRIDGET P BAHNEMAN, CNM Independent Lab CENTRAL REGIONAL PATHOLOGY Physician Group CHILDRENS HOSPITALS & CLINIC Physician Group CHILDRENS RESPIRATORY & CRITICAL CARE SPECIALISTS Physician Group CONSULTING RADIOLOGISTS LTD CORNER MEDICAL CENTER PHARMACYPharmacy Physician Group DC WEST Physician Group DENFELD MEDICAL CENTER Physician Group DULUTH CLINIC HERMANTOWN Physician Group DULUTH CLINIC LAKESIDE Physician Group DULUTH CLINIC LTD Pharmacy DULUTH CLINIC PHARMACY DULUTH CLINICHERMANTOWNPHARM Pharmacy Pharmacy DULUTH CLINICWEST PHARM Physician Group DULUTH FAMILY PRACTICECENTE Pharmacy ECONOFOODS PHARMACY #328 Hospital ESSENTIA HEALTH DULUTH ESSENTIA HEALTH ST MARYS MEDICALHospital CENTER Physician Group FAIRVIEW ELLSWORTH CLINIC Hospital FAIRVIEW LAKES REGIONAL Hospital FAIRVIEW RED WING HOSPITAL Physician Group FAIRVIEW REDWING HEALTH Pharmacy FAIRVIEW UNIVERSITY DISCHARGE PHARMACY Physician Group FAMILY MEDICINE OF WINONA PA Pharmacy FOND DU LAC CAIR PHARMACY Physician Group GROUP HEALTHPLAN INC HEALTHEAST MEDICAL LABORATOR Independent Lab Hospital HEALTHEAST ST JOHNS HOSPITAL Page 64 of 114
SFY 2007 $30 $1,816
SFY 2008 $143 $1,946
SFY 2009 $219 $770
SFY 2010 $253 $1,575 $12 $48 $241 $76 $666 $30 $108 $58 $13,874 $815 $180
$772
$25 $22 $694
$136 $363 $27 $58 $11,796 $700 $210 $125 $1,822 $1,651
$10,032 $1,314 $135 $155
$11,808 $513 $121
$28 $184
$3,359 $412 $24 $11
$2,054 $11
$1,808 $40
$40 $48 $332 $220 $775
$96 $86 $326 $119 $49 $37 $27 $85 $112
Total $615 $30 $6,107 $12 $48 $401 $99 $2,495 $30 $136 $115 $47,510 $3,343 $135 $511 $155 $125 $7,234 $2,102 $184 $24 $1,819 $80 $96 $134 $369 $693 $909 $112
Billing Provider Name HEALTHEAST WOODWINDS HOSPITA HENNEPIN FACULTY ASSOCIATES HENRY K BONG, MD HOSPITAL PATHOLOGY ASSOC PA INDEPENDENT LAB DULUTH JULIE S CRONK, MD KMART PHARMACY 7214 LABORATORY MEDICINE SPECIALI
Billing Provider Type SFY 2007 Hospital Physician Group Physician Physician Group $341 Independent Lab $8,251 Physician Pharmacy $396 Physician Group $551 Federally Qualified Health Clinic (FQHC) LAKE SUPERIOR COMMUNITY HLTH $147 LAKEVIEW COMMUNITY PHARMACY Pharmacy Pharmacy LAKEVIEW HOSPITAL PHARMACY $682 Hospital LAKEVIEW MEMORIAL HOSPITAL $12 Independent Lab LCM PATHOLOGISTS PC $1,772 Physician Group MAYO CLINIC $60 Physician Group MAYO CLINIC HEALTH SYSTEM LAKE CITY-WABASHA CLINIC $122 Pharmacy MAYO CLINIC PHARMACY $192 MAYO CLINIC PHARMACY BALDWIN Pharmacy $46 Pharmacy MAYO CLINIC PHARMACY EISENBE MAYO CLINIC PHARMACY NORTHWE Pharmacy $96 Independent Lab MAYO MEDICALLABORATORIES $2,359 Independent Lab MEDTOX LABORATORIES INC Physician METROPOLITAN UROLOGIC SPECIALISTS, P.A. Group $30 Physician Group MIDWEST SPINE INSTITUTE $139 Physician Group MILLER CREEK MEDICAL CLINIC MINNESOTA ONCOLOGY HEMATOLOGYPhysician Group PA $47 Physician NADEEM IQBAL, MD $77 Physician Group NORTHLAND FAMILY PHYSICIANS NORTHLAND NEUROLOGY & MYOLOG Physician Group Page 65 of 114
SFY 2008 $23
SFY 2009 $24
SFY 2010 $68 $143 $332 $24,921 $733 $1,531 $324
Total $47 $68 $143 $1,053 $65,340 $54 $1,129 $3,798 $1,179 $107 $1,936 $243 $1,800 $2,073 $839 $192 $46 $115 $96 $9,451 $967 $71 $292 $225 $136 $77 $30 $30
$359 $12,891
$22 $19,277 $54 $928 $260 $608 $140 $108 $219
$787 $448 $107 $646 $51 $28 $213 $193
$39 $1,692 $305
$115 $2,110 $2,944 $196 $30 $225 $2,038 $771 $41
$123 $88
$30 $30
Billing Provider Name Billing Provider Type Physician Group NORTHLAND OBGYN ASSOC PA Physician Group ORTHOPAEDIC ASSC OF DULUTH Hospital PARK NICOLLET METHODIST HOSP Pharmacy PARKVIEW PHARMACY Physician PETER F BORNSTEIN, MD Hospital PHILLIPS EYE INSTITUTE Physician Group PS RUDIE MD AND ASSOCIATES Physician Group PS RUDIE MEDICAL CLINIC Independent Lab QUEST DIAGNOSTICS LLC IL Physician Group RADIOLOGISTS ASSOC IN DULUTH Pharmacy RED WING CORNER DRUG Pharmacy REDPHARM DRUG INC Hospital REGINA MEDICAL CENTER Physician Group REGINA MEDICAL GROUP Hospital REGIONS HOSPITAL Independent Lab RIVER FALLS AREA HOSPITAL Physician ROBERT O HILDEBRANDT, MD Hospital ROCHESTER METHODIST HOSP Pharmacy SHOPKO PHARMACY #2114 Physician Group ST CROIX ORTHOPAEDICS PA Hospital ST ELIZABETHHOSPITAL Physician Group ST LUKES ANESTHESIA ASSOCIATES ST LUKES CARDIOLOGY ASSOCIATES Physician Group ST LUKES DERMATOLOGY ASSOCIATESPhysician Group Physician Group ST LUKES EMERGENCY SERVICES Physician Group ST LUKES ENDOCRINOLOGY ASSOCIATES Physician ST LUKES GASTROENTEROLOGY ASSOCIATES Group Hospital ST LUKES HOSPITAL Anesthetist ST LUKES HOSPITAL CRNA Page 66 of 114
SFY 2007 $1,545
SFY 2008 $1,205
SFY 2009 $2,364 $120
SFY 2010 $3,891 $164 $257 $48
$368 $135 $2,012 $86 $2,335 $30 $3,038 $104 $353 $672 $166 $43 $85 $66 $214 $30 $897 $61 $82 $551 $192 $94 $48 $136 $22 $22 $79 $3,149 $152 $48 $325 $105 $672 $2,980 $280 $564 $689
$255 $217
$148 $29 $176
$69
$76
$4,702 $202
Total $9,006 $164 $120 $257 $48 $368 $220 $703 $10,366 $384 $564 $1,445 $701 $393 $166 $43 $85 $66 $1,662 $352 $82 $94 $48 $136 $43 $152 $127 $8,253 $308
Billing Provider Name Billing Provider Type Independent Lab ST LUKES HOSPITAL OF DULUTH Physician Group ST LUKES INTERNAL MEDICINE ASSOCIATES Physician Group ST LUKES RHEUMATOLOGY ASSOCIATES Physician Group ST LUKES URGENT CARE Hospital ST MARYS HOSPITAL Physician Group ST PAUL RADIOLOGY PA Physician Group STILLWATER MEDICAL GROUP SUBURBAN RADIOLOGIC CONSULTA Physician Group Pharmacy TARGET STORE T-0004 PHARMACY Pharmacy TARGET STORE T-0931 PHARMACY Pharmacy TARGET STORE T-1096 PHARMACY Pharmacy TARGET STORE T-1522 PHARMACY Physician Group THE CHILDRENS HEART CLINIC Physician THOMAS A WEBER, MD Physician Group THREE RIVERSPATHOLOGYPA Pharmacy THRIFTY WHITE DRUG #726 Independent Lab TWIN CITIES DERMATOPATHOLOGY Hospital UNITED HOSPITALS INCORPORATE Hospital UNIVERSITY OF MINNESOTA MEDI Physician Group UNIVERSITY OFMINNESOTAPHYSIC Pharmacy WABASHA PHARMACY Pharmacy WAL MART PHARMACY 10 1971 Pharmacy WAL MART PHARMACY 10 2367 Pharmacy WALGREENS #02784 Pharmacy WALGREENS #11834 Pharmacy WALGREENS 05048 Pharmacy WALGREENS 06916 Pharmacy WALGREENS 07126 Pharmacy WALGREENS 07727 Page 67 of 114
SFY 2007 $2,433
$838
SFY 2008 $2,972 $30 $27 $946 $12 $627 $508 $905
SFY 2009 $2,181
$363 $273 $2,957 $12 $1,586 $63
$1,027
SFY 2010 $4,881 $30 $30 $776 $27 $243 $2,098 $218 $1,371 $132 $799
$127 $90
$47 $22 $5,418 $177 $3,696 $130 $160 $12 $222 $178 $393 $166 $455 $386 $258 $1,696 $226 $279 $1,926 $313 $1,749 $1,966 $196 $1,504 $58 $163 $13 $146 $28 $76 $1,241 $1,288 $1,888 $1,248
Total $12,467 $60 $57 $2,922 $39 $516 $6,710 $12 $725 $3,990 $285 $799 $47 $22 $12,250 $177 $130 $160 $207 $222 $1,739 $163 $406 $312 $28 $1,069 $3,376 $537 $6,876
Billing Provider Name WAL-MART PHARMACY 10-1472 WAL-MART PHARMACY 10-1861 WAL-MART PHARMACY 10-2643 WAL-MART PHARMACY 10-5397 WILLIAM K SCHWARTAU, MD WINONA CLINIC LTD WINONA CLINIC PHARMACY WINONA HEALTH SERVICES
Monroe
Oconto
Billing Provider Type SFY 2007 Pharmacy Pharmacy Pharmacy Pharmacy Physician Physician Group $111 Pharmacy $346 Hospital Physician Group Physician Group GUNDERSEN CLINIC LTD $1,820 Pharmacy JACKSON DRUGCO INC $473 Physician JOEL D ERICKSON, MD $100 Nurse Practitioner LYNNE H POLODNA, NP $57 Rural Health Clinic MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE $30 Hospital MAYO CLINIC HEALTH SYSTEM FRANCISCAN HEALTHCARE-SP Pharmacy MEDICINE SHOPPE 1798 $2,119 Pharmacy PHILLIPS TOMAH PHARMACY $307 Federally Qualified Health Clinic (FQHC) SCENIC BLUFFS COMMUNITYHEALT $155 Pharmacy SCENIC BLUFFS HEALTH CENTER $291 Pharmacy SPARTA PHARMACY LLC Pharmacy THE MEDICINE SHOPPE #1798 Physician Group TOMAH MEMORIAL HOSPITAL Hospital TOMAH MEMORIAL HOSPITAL INC Pharmacy WALGREENS 09168 $3,927 Pharmacy WAL-MART PHARMACY 10-0965 $3,374 Pharmacy WAL-MART PHARMACY 10-0979 $2,475 Nurse Practitioner BARBARA A PESOLA, NP Physician Group CMH CENTER FOR WOMENS CARE Page 68 of 114
SFY 2008 $211
SFY 2009 $377 $435
SFY 2010 $114 $768 $821 $12 $413
$142 $50 $1,164 $436 $60 $1,853
$226 $36
$22 $221 $1,023 $511 $168 $182 $1,183 $903 $7,568 $3,109 $2,830 $1,886 $58 $2,641 $1,281 $165 $87 $282 $1,551 $158 $5,108 $6,990 $4,963 $1,874 $128 $5,592
$2,291 $349 $60 $221 $227
Total $377 $761 $768 $821 $12 $254 $759 $486 $286 $4,873 $473 $100 $79 $88 $2,861 $5,432 $2,447 $547 $599 $691 $2,734 $158 $6,212 $22,214 $15,021 $9,472 $128 $8,157
$202 $3,729 $3,575 $2,294 $679
Billing Provider Name COMMUNITY MEMORIAL HOSPITAL
Oneida
Billing Provider Type Hospital Pharmacy Physician Group Physician Group FMC OCONTO Rural Health Clinic Rural Health Clinic FMC OCONTO FALLS Physician Group FMC SURING Physician JUDITH E BOWERS, DO Physician MEGAN E TEMP, MD Physician Group NEW WOMENS HEALTHCARE ASSOC Family Planning Clinic NEWCAP WHS Federally Qualified Health Clinic (FQHC) NICOLET HEALTH CLINIC Pharmacy NICOLET PHARMACY INC Pharmacy OCONTO FALLS PHARMACY Hospital OCONTO HOSPITAL & MEDICAL CE Independent Lab OCONTO HOSPITAL & MEDICAL CENTER Physician Group OCONTO HOSPITAL AND MEDICAL CLINIC Pharmacy OCONTO PHARMACY BF Pharmacy PAMIDA PHARMACY 833 Independent Lab PREVEA HEALTH Physician RENATE G MUNARI, MD Nurse Practitioner SUSAN A PATERSON, CNM Nurse Practitioner ARLENE V KELLETT, NP Physician Group ASPIRUS RHINELANDER CLINIC Physician Group ASPIRUS THREE LAKES CLINIC Pharmacy BACKES APOTHECARY PHARMACY Physician DAVID A KNUFF, MD Physician Group FAMILY HEALTHSERVICES SC Page 69 of 114
SFY 2007 $3,662 $96 $1,362 $51 $244 $57 $483
SFY 2008 $5,863 $292 $1,361 $116 $103 $1,149 $173 $399,225 $1,636 $1,437 $2,910
SFY 2009 $20,187 $549 $1,726 $43 $52 $58
SFY 2010 $20,283 $1,687 $5,577 $611 $405 $133
$251,394 $955 $1,735 $3,719 $292
$327 $452,780 $1,354 $1,044 $3,266 $422
$95 $751,768 $2,522 $2,446 $3,073 $7,004 $401 $91 $731 $1,165 $369
Total $49,994 $2,624 $10,026 $611 $210 $803 $248 $1,632 $173 $421 $1,855,167 $6,466 $6,662 $12,968 $7,718 $401 $91 $7,646 $3,852 $369 $132 $818 $188 $2,110 $391 $2,595 $49 $3,110
$3,497 $1,259 $132
$2,234 $561
$1,184 $867
$818 $84 $37 $871 $1,014 $188 $762 $78 $567 $469 $1,264 $276 $427 $49 $474
$730 $1,153
Billing Provider Name Billing Provider Type Independent Lab HOWARD YOUNGMEDICAL CENTER HOWARD YOUNGMEDICAL CENTER INCHospital Nurse Practitioner JANET R BOWEN, NP Physician JON W POTTER, DO Physician JOSEPH P KIM, MD Ambulatory Surgical Center (ASC) MARSHFIELD CLINIC MINOCQUA A Independent Lab MARSHFIELD CLINIC MINOCQUA C Physician Group Pharmacy MARSHFIELD CLINIC PHARMACY Physician Group MINISTRY MEDICAL GROUP Nurse Practitioner NADINE B BOND, NP Physician Group NORTHERN WISCONSIN BONE& JOI Physician Group NORTHLAND ORTHOPEDIC ASSOC ONEIDA COUNTYHEALTH DEPARTME Family Planning Clinic Physician Group PREMIER PHYSICAL MEDICINE AND WELLNESS CLINIC Physician Group REDMAN & GELINAS SC Physician ROBERT J AYLESWORTH, MD SACRED HEART ST MARYS HOSPITAL Physician Group Independent Lab SACRED HEARTST MARYS HOSPIT Pharmacy SHOPKO PHARMACY #2170 Physician Group SMH MINISTRYMED GRP RIVERSI Hospital ST MARYS HOSPITAL Physician Group STOXEN PROFESSIONAL PHARMACY Pharmacy Pharmacy THREE LAKES PHARMACY Pharmacy TRIGS PHARMACY Pharmacy WALGREENS #01158 Pharmacy WALGREENS 07880 Page 70 of 114
SFY 2007 $1,643 $229
SFY 2008 $3,611 $252
SFY 2009 $318 $25,112 $317 $52 $55
SFY 2010 $845 $23,756 $233 $55 $22
Total $1,163 $54,121 $1,031 $108 $77 $2,171 $1,984 $4,074 $17,396 $149 $3,868 $86 $237 $633,703 $640 $48 $22 $93,180 $2,350 $13,502 $43 $66,790 $85 $12,913 $1,275 $18,093 $18,910 $33,524
$724 $526 $2,049 $4,280
$1,447 $778 $2,025 $4,044
$561 $3,677 $2,819 $86
$119 $5,396 $149 $1,049 $237 $163,585 $267 $48 $42,108 $1,069 $3,758 $43 $39,142 $2,516 $192 $6,004 $6,782 $10,120
$157,060
$162,293 $373
$150,765
$22 $15,575 $1,035 $3,862 $867 $3,110 $500 $4,723 $4,141 $5,711
$18,656 $11 $2,765 $4,905 $4,401 $401 $3,572 $2,477 $8,354
$16,841 $235 $3,117 $21,875 $85 $2,885 $182 $3,795 $5,510 $9,339
Other Border
Outagamie
Billing Provider Name Billing Provider Type Pharmacy WAL-MART PHARMACY 10-1931 Pharmacy WAL-MART PHARMACY 10-2510 Independent Lab ASSOCIATED REGIONAL & UNIVER Independent Lab BOSTWICK LABORATORIES INC Independent Lab DYNACARE NORTHWEST INC Independent Lab GENZYME GENETICS Independent Lab LABONE INC Independent Lab LABORATORY CORPORATIONOF Independent Lab LABORATORY CORPORATIONOF AM Independent Lab NATIONAL HEALTH LABORATORY Independent Lab QUEST DIAGNOSTICS Independent Lab QUEST DIAGNOSTICS INC Independent Lab QUEST DIAGNOSTICS NICHOLS INSTITUTE OF VALENCIA IN Independent Lab SANFORD SM USD CLINICAL VIRO Physician Group AASCEND PAIN INSTITUTE SC Physician SC APPLETON AREA ANESTHESIA & PAIN SERVICES,Group Physician Group ASSOCIATES IN GASTROENTEROLOGY, SC Pharmacy AURORA PHARMACY INC Physician BRIAN KIESNOWSKI, MD Physician BRIAN L LOHRBACH, MD Physician BRIAN L VANHOOZEN, DO Physician Group BUTTE DES MORTS PATHOLOGY SC Physician Group COMPREHENSIVE PAIN MANAGEMENT OF FOX VALLEY Pharmacy CONSUMER PRESCRIPTION CENTER COPPS FOOD CENTER PHARMACY #8118Pharmacy COPPS FOOD CENTER PHARMACY #8187Pharmacy Pharmacy CUB PHARMACY#673 Pharmacy CVS PHARMACY #08525 Physician DANIEL F WENDELBORN, MD Page 71 of 114
SFY 2007 $4,497 $5,909
SFY 2008 $3,949 $4,270 $49
SFY 2009 $4,969 $2,725 $1,568
SFY 2010 $9,896 $7,598 $1,674
$119 $21 $814 $3,782 $2,242 $264 $243 $1,472 $44 $830 $97 $49 $152 $124 $125 $856 $121 $152 $6,336 $205 $216 $529 $454 $3,002 $30 $1,978 $4,463 $126
$98 $134 $49
$69
$193 $90 $103 $3,040 $2,071
$558
$48 $504
$3,108 $47
$58 $3,617 $505
$29 $2,325
$5,822
$2,107
Total $23,311 $20,502 $49 $3,242 $119 $21 $814 $11,695 $170 $3,071 $98 $564 $49 $291 $152 $124 $172 $2,110 $90 $121 $312 $16,101 $205 $2,839 $529 $454 $29 $13,256 $30
Billing Provider Name Billing Provider Type Physician DAVID J BROOKS, MD Physician DERMATOLOGY ASSOCIATES OF WISCONSIN SC Group Physician DOUGLAS S YEATMAN, MD Physician Group FAMILY CARE OF THE FOXCITIES Physician Group FMC SEYMOUR Pharmacy FORD PHARMACY Pharmacy FORD PHARMACY NORTH Physician Group FOX CITIES EYE CLINIC SC FOX VALLEY HEMATOLOGY & ONCO Physician Group Physician Group FOX VALLEY NEPHROLOGY PARTNE Physician Group FOX VALLEY PULMONARY MEDICIN Physician Group FOX VALLEY REPRODUCTIVE MEDICINE Physician Group FOX VALLEY SURGICAL ASSOCIAT Physician Group HAND AND UPPER EXTREMITY CTR Physician Group IHC-ST ELIZABETH EMERGENCY PHYSICIANS, LLC Physician Group INTEGRITY MEDICAL GROUP SC Pharmacy JERNEGANS HEALTH MART Physician JON J CHERNEY MD, MD Physician Group KAGEN ALLERGYCLINIC SC Physician Group KAUKAUNA CLINIC SC Physician KENT C SCHAEFER, MD Pharmacy KIMBERLY PHARMACY INC Nurse Practitioner LYNN K DAHLKE, NP Physician MICHAEL S FAUDREE, MD Pharmacy MORTON PHARMACY Physician Group NEUROSPINE CENTER OF WI SC Physician Group NEW ANESTHESIOLOGY SC Hospital NEW LONDON FAMILY MEDICAL Independent Lab Page 72 of 114
SFY 2007
SFY 2008 $47
SFY 2009
SFY 2010 $186 $30 $86 $121
Total $47 $186 $30 $203 $121 $159 $152 $134 $704 $149 $48 $5,154 $133 $55 $49 $83 $10,795 $55 $236 $1,941 $37 $870 $74 $43 $7,448 $171 $79 $15,865 $1,298
$30 $159 $114 $121
$87
$38 $48 $134 $536 $149 $48 $2,483 $133 $27 $83 $1,883 $55 $236 $676 $37
$2,671 $55 $22 $2,607 $4,573 $1,732
$249 $400
$339 $391 $43 $1,203
$678 $79 $74 $1,093
$2,763
$230 $95
$459 $111
$4,748 $247
$2,390 $171 $79 $10,428 $846
Billing Provider Name Billing Provider Type NORTH THEDACARE FAMILY MEDICINEPhysician Group Federally Qualified Health Clinic (FQHC) ONEIDA COMMUNITY HEALTH Pharmacy OSCO DRUG #509 Physician Group OSTEOPATHIC MEDICINE &PHYSIC Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician PRIMARY CARE ASSOCIATES OF APPLETON, LTDGroup RADIATION ONCOLOGY SPECIALISTS Physician Group RADIOLOGY ASSOCIATES OF APPLETONPhysician Group Pharmacy SAM'S PHARMACY 10-6321 Pharmacy SEYMOUR PHARMACY TLSMEINC Pharmacy SHOPKO PHARMACY #2015 Pharmacy SHOPKO PHARMACY #2028 Pharmacy SHOPKO PHARMACY #504 Pharmacy SHOPKO PHARMACY #505 Independent Lab ST ELIZABETH HOSPITAL INC Hospital ST ELIZABETHHOSPITAL Physician STEPHEN C DUNGAR, MD Pharmacy TARGET STORE T-1248 PHARMACY Physician Group TCP INTERNAL MED ECH Physician Group THEDA CARE PHYSICIANS Physician Group THEDACARE ORTHOPEDICS PLUS P THEDACARE PHYSICIANS- BLACK CREEKhysician Group THEDACARE PHYSICIANS KIMBERLY Physician Group Physician Group THEDACARE PHYSICIANS- WEST Physician TIMOTHY B RASOR, MD Physician Group UW MEDICAL FOUNDATION FOX VA Physician Group UW SYSTEMS Physician Group VALLEY EYE ASSOCIATES Page 73 of 114
SFY 2007 $1,654 $13,829 $1,483 $236 $515,140 $455
SFY 2008 $1,644 $20,351
SFY 2009 $4,692 $27,944
SFY 2010 $22,497 $43,685 $30 $149,115 $2,187 $48 $253 $535 $1,313 $4,841 $4,181 $996 $1,182 $18,660 $26,073 $3,259 $97 $356
Total $30,487 $105,809 $1,483 $266 $1,199,363 $4,407 $48 $433 $773 $5,623 $14,601 $15,238 $1,749 $2,801 $41,263 $44,417 $158 $7,596 $884 $3,439 $356 $101 $2,652 $721 $64 $1,769 $485 $99
$384,354 $901 $12
$150,755 $864 $168 $238 $2,328 $3,901 $4,345 $753 $1,619 $9,951 $15,743 $1,603 $591 $1,381 $101 $75 $130 $12 $47
$832 $3,134 $2,367
$1,149 $2,724 $4,345
$5,636 $358 $158 $721 $43 $739
$7,017 $2,243 $2,012 $153 $1,319
$2,144 $294 $1,003 $252
$434 $297 $766 $186
$52
$99
Out-of-State
Billing Provider Name Billing Provider Type Physician Group VALLEY ORTHOPEDIC CLINIC SC Physician Group VALLEY UROLOGIC ASSOCIATES Pharmacy WALGREENS #02921 Pharmacy WALGREENS #10234 Pharmacy WALGREENS #10759 Pharmacy WALGREENS #12019 Pharmacy WALGREENS #12693 Pharmacy WALGREENS 05102 Pharmacy WALGREENS 07323 Pharmacy WALGREENS 09682 Pharmacy WAL-MART PHARMACY 10-1982 Physician Group WOMENS CARE OF WISCONSIN Physician Group WOMENS HEALTH SPECIALISTS SC Hospital ALEXIAN BROTHERS MED CTR Independent Lab AMERIPATH FLORIDA LLC Independent Lab ASCEND CLINICAL LLC AUBURN REGIONAL MEDICAL CENTER Hospital Hospital BANNER THUNDERBIRD MEDICAL Hospital BAPTIST MEMORIAL HOSPITAL Hospital BARAGA COUNTY MEMORIAL HOSPITAL Hospital BAYLOR MEDICAL CENTER AT GRAPEVINE Hospital BUFFALO HOSPITAL Hospital CAMBRIDGE MEDICAL CENTER Hospital CENTEGRA HOSPITAL MCHENRY Hospital CGH MEDICAL CENTER Pharmacy CVS PHARMACY# 05600 Hospital FLORIDA HOSPITAL MEDICAL Hospital HALIFAX MEDICAL CENTER Hospital HARDIN MEMORIAL HOSPITAL Page 74 of 114
SFY 2007 $30 $10,075 $3,359
SFY 2008
SFY 2009 $22 $7,703 $3,877 $4,577 $12,276 $5,702 $2,939 $4,387 $4,292 $1,377 $13,539
$12,657 $5,426 $2,792 $10,412 $5,184 $5,439 $3,626 $5,834 $6,718 $12,485 $146
$7,844 $3,862 $5,476 $1,762 $7,794 $1,559 $11,404
SFY 2010 $85 $86 $6,074 $10,232 $3,885 $2,164 $13,290 $6,646 $5,461 $5,389 $8,767 $1,393 $16,888 $80
Total $85 $137 $36,509 $22,895 $11,254 $2,164 $43,821 $21,394 $19,315 $15,165 $26,688 $11,045 $54,316 $80 $146 $52 $22 $123 $56 $13 $35 $41 $433 $11 $60 $972 $121 $12 $16
$52 $22 $123 $56 $13 $35 $41 $433 $11 $62 $12 $16 $60 $910 $121
Billing Provider Name Billing Provider Type Hospital IOWA METHODIST MEDICALCENTE JACKSON MADISON COUNTY GENERAL Hospital HOSP Independent Lab LABORATORY CORPORATIONOF Hospital LEESBURG REGIONAL MEDICAL MEDICAL DIAGNOSTIC LABORATORIES Independent Lab LLC Hospital MEMORIAL HOSPITAL Hospital MEMORIAL MEDICAL CENTER Hospital MERCY HOSPITAL OF FRANCISCAN METHODIST HEALTHCARE MEMPHIS Hospital Hospital METROSOUTH MEDICAL CENTER Hospital MIDWESTERN REGIONAL Hospital MOUNTAINVIEWHOSPITAL Independent Lab OUR LAB Hospital PORTAGE HOSPITAL Physician RANDALL S VOLLERTSEN, MD Hospital ROSELAND COMMUNITY HOSPITAL Hospital RUSH UNIVERSITY MEDICAL CENT Hospital ST ANTHONY NORTH HOSPITAL Hospital ST FRANCIS HOSPITAL Hospital ST FRANCIS REGIONAL MEDICAL Hospital ST LUKES METHODIST HOSPITAL Hospital ST MICHAELS HOSPITAL Hospital ST ROSE DOMINICAN DI LIMA Hospital ST VINCENT HOSPITAL HEALTH Hospital SUMMIT MEDICAL CENTER Pharmacy THE MEDICINE SHOPPE #1855 Hospital THE METHODIST HOSPITALS INC Hospital THE TOLEDO HOSPITAL Hospital TRINITY HOSPITAL Page 75 of 114
SFY 2007
SFY 2008 $100
SFY 2009 $120 $2,006 $1,175 $112 $12 $11 $11
SFY 2010 $11
Total $11 $220 $14 $2,006 $9,305 $112 $646 $12 $81 $128 $11 $310 $107 $12 $78 $66 $61 $23 $31 $32 $10 $3,945 $12 $336 $12 $2,023 $12 $117 $59
$14 $194 $7,936 $646 $71 $128 $310 $107 $12 $78 $66 $61 $23 $31 $12 $3,945 $12 $336 $12 $618 $12 $117 $24 $1,405 $20 $10
$35
Ozaukee
Billing Provider Name Billing Provider Type Hospital UNITY HOSPITAL Hospital UNIVERSITY HOSPITAL Independent Lab VERNON MEMORIAL HEALTHCARE Hospital VISTA MEDICAL CENTER EAST Hospital VISTA MEDICAL CENTER WEST Hospital WEST SUBURBAN HOSPITALMED AURORA MEDICAL GROUP WEST BEND Physician Group Pharmacy AURORA PHARMACY INC Physician CAROL J ESTILL, MD Hospital COLUMBIA CENTER INC Pharmacy CVS PHARMACY#08775 Physician DONALD J MEYER, DO Physician INDIRA MAMMEN, MD Physician Group INTERPEDIA SC Physician JAIME D CABATINGAN, MD Physician Group JANICE ALEXANDER RN MD SC Physician JANICE H ALEXANDER, MD Physician JOHN F LESKO, MD Physician JULIE A CHICKS, MD Physician Group MILWAUKEE ENT CLINIC LTD Physician Group NORTH SHORE DERMATOLOGY SC Physician Group NORTHEAST OB GYN SC Physician Group NORTHSHORE GYNECOLOGY Physician Group ORTHOPAEDIC ASSOCIATES OF MILWAUKEE, S.C. Pharmacy OSCO DRUG #5778 Physician Group OZAUKEE MEDICAL CENTER Physician ROBERT R STUMPF, MD Transportation ROYAL MEDICAL TRANSPORTATION Physician SALVADOR V DELROSARIO, MD Page 76 of 114
SFY 2007
SFY 2008
$107
SFY 2009 $100 $100 $237
SFY 2010
$327 $22 $11 $5,391 $977 $418 $425 $95
$5,770
$1,717
$12 $1,827 $122 $30
$69 $790
$83 $1,136 $794
$86 $30 $20 $47 $57 $95 $66 $55 $112 $22 $35 $30 $43 $304 $60 $109 $1,667 $111 $32 $1,826 $322
Total $100 $100 $671 $22 $11 $12 $14,706 $1,099 $30 $418 $577 $95 $2,720 $86 $30 $342 $104 $109 $1,762 $66 $166 $144 $1,826 $22 $35 $30 $43 $304 $60
Billing Provider Name SHOPKO EXPRESS #503 SHOPKO PHARMACY #2090 SMO PHYSICIANS ST MARYS HOSPITAL OZAUKEE
Pepin
Pierce
Billing Provider Type Pharmacy Pharmacy Physician Group Hospital Physician Group Pharmacy TARGET STORE T-1212 PHARMACY Physician Group THIENSVILLE FAMILY HEALTH Nurse Practitioner THUROW PRIMARY PREVENTIVE HEALTHCARE SC Transportation TNJ TRANSPORT LLC Physician Group UNITED OCCUPATIONAL MEDICINE & WALK IN SERVICES, L Physician VICTORIA J MONDLOCH, MD Pharmacy WALGREENS Pharmacy WALGREENS #01988 Pharmacy WALGREENS #13620 Pharmacy WALGREENS 03448 Pharmacy WALGREENS 04884 Pharmacy WAL-MART PHARMACY 10-1650 Physician Group WISCONSIN RADIOLOGY SPECIALISTS SC Pharmacy YE OLDE PHARMACY & WELLNESS Physician Group CASTLEBERG CLINIC SC Hospital CHIPPEWA VALLEY HOSPITAL Pharmacy ECONOFOODS PHARMACY 323 Pharmacy HEIKE PHARMACY INC Nurse Practitioner JANE M POESCHEL, NP Physician KENNETH M RUCKER, MD Physician MICHELLE L BANDY, MD Family Planning Clinic PEPIN COUNTYNURSING SERVICE Physician Group ALLINA MEDICAL CLINIC PRESCO Pharmacy ECONOFOODS PHARMACY #322 Page 77 of 114
SFY 2007 $199 $591 $945 $762 $249
SFY 2008 $155 $273 $30 $533 $602 $149 $45 $115 $57 $2,550 $828 $699 $695 $597 $1,429 $155 $151 $1,554 $1,403 $2,686 $140
SFY 2009 $87 $192 $11,110 $918 $1,145 $198
SFY 2010 $1,634 $346 $10,632 $635 $103 $191
$1,656 $774 $195 $1,012 $31 $1,214 $244 $263 $1,899 $2,147 $39
$1,540 $427 $1,283 $1,003 $258 $1,251 $717 $180 $292 $1,224 $2,478 $440 $30 $112 $11,466 $3,567
$3,863 $3,665 $2,410 $1,023 $2,357 $3,019 $748 $394 $86 $1,218 $796 $1,936 $848 $215 $18,677 $308 $1,955
$11,312 $2,240
$10,704 $2,464
Total $2,075 $1,401 $30 $23,220 $2,282 $2,029 $450 $191 $45 $115 $57 $9,609 $5,695 $4,586 $3,733 $3,243 $6,913 $1,619 $638 $679 $3,064 $5,322 $9,246 $1,466 $30 $328 $52,159 $308 $10,226
Polk
Billing Provider Name ELLSWORTH MEDICAL CLINIC FAIRVIEW ELLSWORTH CLINIC FREEMAN DRUGINC MOST PHARMACY PAMIDA PHARMACY #654 PIERCE CO REPRODUCTIVE HEALTH RIVER FALLS AREA HOSPITAL RIVER FALLS MEDICAL CLINIC SPRING VALLEY DRUG SPRING VALLEYMEDICAL CLINIC VILLAGE PHARMACY AMERY REGIONAL MEDICALCENTE AMERY REGIONAL MEDICALCENTER BALSAM LAKE PHARMACY INC BRADLEY S HARLANDER, DDS CHET JOHNSON& SONS DRUG CLINIC PHARMACY OSCEOLA JOHNSON DRUGAT ARMC LADD MEMORIAL HOSPITAL LUCK MEDICAL CLINIC LUCK MEDICALCLINIC SC LUCK PHARMACY INC OSCEOLA MEDICAL CENTER OSCEOLA PHARMACY PAMIDA PHARMACY 228 PAUL A HAUGEDDS LTD
Billing Provider Type Physician Group Physician Group Pharmacy Pharmacy Pharmacy Family Planning Clinic Hospital Physician Group Pharmacy Physician Group Pharmacy Independent Lab Hospital Physician Group Pharmacy Dentist Pharmacy Pharmacy Pharmacy Hospital Physician Group Rural Health Clinic Physician Group Pharmacy Independent Lab Physician Group Pharmacy Pharmacy Dentist Page 78 of 114
SFY 2007 $60 $1,040 $643 $1,755 $342,034 $661 $4,716 $381 $103 $134 $100 $7,988 $3,873 $2,670 $733 $948 $1,092 $30 $87 $127 $1,057 $169 $2,052 $37 $636 $236
SFY 2008 $305 $598 $1,161 $643 $84 $301,354 $4,420 $5,284 $1,146 $100 $506 $1,296 $7,801 $1,289 $262 $686 $1,257 $385 $3,290 $295 $178 $348 $475 $825 $515
SFY 2009 $2,668 $1,980 $953 $609 $344,000 $6,218 $8,824 $1,113
SFY 2010 $2,840 $2,977 $452 $938 $436,680 $9,512 $13,349 $559
$2,573 $4,389 $14 $1,538 $2,993 $410 $16,433 $185 $313 $76 $1,542 $79
$23 $7,177 $4,121 $1,105 $2,328 $3,274 $1,423 $10,696 $1,070 $172 $50 $2,195 $105
Total $365 $7,146 $6,760 $3,802 $1,630 $1,424,068 $20,810 $32,173 $3,198 $203 $640 $23 $11,147 $24,299 $6,281 $262 $7,222 $8,257 $3,165 $31,511 $325 $1,520 $960 $1,658 $169 $6,615 $220 $1,151 $236
Portage
Billing Provider Name Billing Provider Type Family Planning Clinic POLK CO HEALTH DEPARTMENT Physician RENE B MILNER, MD Pharmacy RIVER VALLEYPHARMACY Physician Group ST CROIX REGIONAL MEDICAL Independent Lab ST CROIX REGIONAL MEDICAL CE ST CROIX REGIONAL MEDICAL CENTER Hospital Physician Group ST CROIX VALLEY SURGICAL ASC Pharmacy TANGEN DRUG INC Pharmacy THE MEDICINE SHOPPE #1855 Pharmacy THE MEDICINESHOPPE Pharmacy WAL-MART PHARMACY 10-2421 Physician Group ASPIRUS ROSHOLT FAMILY Physician Group ASPIRUS STEVENS POINT CLINIC Physician Group ASPIRUS STEVENS POINT SENTRY Pharmacy AURORA PHARMACY INC Physician Group CENTRAL WISCRADIOLOGISTS SC COPPS FOOD CENTER PHARMACY #8101Pharmacy COPPS FOOD CENTER PHARMACY #8107Pharmacy COPPS FOOD CENTER PHARMACY #8116Pharmacy Physician JUAN B LOPEZ, MD Pharmacy K MART PHARMACY 7010 Physician Group KLASINSKI CLINIC SC Mental Health and Substance Abuse Services MINISTRY MEDICAL GROUP Physician Group Physician Group MINISTRY MEDICAL GROUP PLOVER FAMILY PRACTICE Independent Lab SAINT MICHAELS HOSPITAL Pharmacy SHOPKO PHARMACY #2055 Page 79 of 114
SFY 2007 $96,091 $1,557 $7,574 $12 $1,597 $22 $2,181 $2,179 $3,991 $30 $348 $8,164
SFY 2008 $99,018 $22 $2,187 $4,556 $68 $2,526 $1,377 $1,981 $5,802 $1,088 $30 $6,645 $285
SFY 2009 $110,173 $1,227 $7,751 $420 $7,539 $1,293 $1,950 $2,267 $2,375 $30 $6,515 $450
SFY 2010 $151,339 $55 $2,764 $13,856 $613 $12,230 $2,143 $271 $1,972 $5,811 $2,788 $762 $391 $1,331 $546 $8,204 $78
$10,377
$22 $9,847
$11,961
Total $456,621 $77 $7,734 $33,737 $1,113 $23,892 $22 $6,994 $271 $6,110 $14,031 $30 $9,622 $60 $24,112 $1,497 $391 $1,331 $546 $22 $40,389 $78
$7,213 $6,530
$3,905 $6,757
$95 $408 $1,760 $2,704 $10,567
$936 $795 $8,179 $849 $8,448
$1,031 $1,203 $9,939 $14,670 $32,303
Billing Provider Name SHOPKO PHARMACY #2171 ST MICHAELS HOSPITAL
Price
Racine
Billing Provider Type Pharmacy Hospital Physician Group Physician ST MICHAELS HOSPITAL OF STEVENS POINT INC Group Physician Group STEVENS POINT SURGICAL SERVICES SC TRIGS COUNTY MARKET PHARMACY Pharmacy Pharmacy UNIVERSITY HEALTH SERVICE PH Family Planning Clinic UWSP STUDENTHEALTH SERVICE Pharmacy WALGREENS #11278 Pharmacy WALGREENS #13074 Pharmacy WALGREENS 06935 Pharmacy WAL-MART PHARMACY 10-1828 Pharmacy AURORA PHARMACY COPPS FOOD CENTER PHARMACY #8127Pharmacy Independent Lab FLAMBEAU HOSPITAL Anesthetist FLAMBEAU HOSPITAL INC Hospital Pharmacy LAKEVIEW PHARMACY Physician MEMORIAL HEALTH CENTER CLINICS PRENTICE Group Pharmacy PAMIDA PHARMACY 319 Physician Group PARK FALLS REGIONAL MEDICAL CLINIC SC Pharmacy PARK PHARMACYINC Family Planning Clinic PRICE COUNTYHEALTH Physician Group ADVANCED MEDICAL IMAGING LLC Physician Group ALL SAINTS MEDICAL GROUP Physician Group AURORA HEALTH CENTER RACINE Physician Group AURORA MEDICAL GROUP Hospital AURORA MEMORIAL HOSPITAL OF Pharmacy AURORA PHARMACY INC Page 80 of 114
SFY 2007 $7,122 $6,867 $18,843 $6,114 $472 $3,407 $42,903 $42,318
SFY 2008 $6,665 $36,297 $21,819 $5,309 $472 $4,176 $86,581 $64,964 $4,992 $21,932 $13,728 $1,782 $19
SFY 2009 $8,014 $136,592 $21,552 $4,465 $2,173 $116,745 $39,361 $10,723 $24,499 $16,491 $2,151
SFY 2010 $9,772 $138,273 $26,660 $5,565 $4,413 $97,925 $17,175 $15,852 $378 $20,736 $20,257 $999 $1,100 $19 $245 $7,538 $1,573 $554 $1,014 $456 $2,606 $100,421
$13,723 $7,289 $450
$228 $1,121 $778 $771 $3,754 $93,342 $15,967 $3,049 $3,310 $176 $2,594
$2,249 $2,099 $1,748 $85 $218 $2,580 $74,280 $5,853 $1,492 $2,770 $3,410
$4,636 $2,997 $173 $1,145 $34 $2,855 $88,997 $28 $3,456 $3,223 $4,577 $3,201
$11,017 $12,662 $4,990 $3,243
Total $31,574 $318,029 $88,875 $21,453 $943 $14,168 $344,154 $163,818 $31,567 $378 $80,890 $57,765 $5,381 $1,100 $37 $245 $14,651 $7,791 $3,254 $3,015 $708 $11,795 $357,040 $28 $21,820 $19,014 $21,965 $9,744 $12,448
Billing Provider Name Billing Provider Type Pharmacy CVS PHARMACY#08776 Physician Group D J KONTRA MD AND ASSOCIATES Physician Group DANA R TROTTER MD SC Optometrist EYE CENTER OFRACINE LTD Physician Group EYE CLINIC OFRACINE LTD Physician Group GREAT LAKES DERMATOLOGY Pharmacy HAUPER PHARMACY Transportation K & S MEDICAL TRANSPORT INC Pharmacy K MART PHARMACY #9713 Pharmacy K MART PHARMACY 3774 Pharmacy K MART PHARMACY 3851 Pharmacy LAKEVIEW PHARMACY OF RACINE Physician MICHAEL A GANZ, MD NORTHWESTERN MEDICAL CENTER SC Physician Group NUTRITIONAL DESIGNS & PHARMACY Pharmacy Pharmacy OSCO DRUG #3626 Pharmacy OSCO DRUG #5790 Physician PATRICIO L ILADA IV, MD Pharmacy PICK N SAVE PHARMACY #6414 Pharmacy PICK N SAVE PHARMACY #6863 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Federally Qualified RACINE COMMUNITY HEALTH CENTER Health Clinic (FQHC) Physician Group RACINE COUNTY PATHOLOGY ASC Pharmacy SHOPKO PHARMACY #2027 Physician Group SOUTHEAST ANESTHESIA CONSULT SOUTHEASTERN WI ANESTHESIOLOGY Physician Group Physician Group SWIFT CARE SC THE PHARMACY STATION BURLINGTONPharmacy Page 81 of 114
SFY 2007 $2,010
SFY 2008 $2,108
SFY 2009 $2,292
SFY 2010 $3,611 $52 $196 $290 $283 $454
$357 $54 $638 $554 $281 $22 $55 $44 $207 $408
$608 $320 $748
$925 $292 $387 $1,363 $198 $476
$615 $362 $1,616 $1,639 $1,479 $2,361
$2,275,131 $55 $975 $4,927 $176 $55 $1,258 $2,930 $176 $55 $1,515 $460 $2,924 $5,816
$173 $65 $13 $6,679,236 $3,514 $4,271 $11,407 $175 $55 $606 $1,978
Total $10,021 $52 $196 $290 $283 $454 $357 $54 $2,786 $1,529 $2,003 $4,032 $22 $1,732 $2,881 $207 $408 $173 $65 $13 $8,954,367 $4,083 $9,427 $25,080 $527 $55 $661 $6,690
$1,995
$1,201
Billing Provider Name THE PHARMACYSTATION WALGREENS #02927 WALGREENS #03022 WALGREENS #10584 WALGREENS 05417 WALGREENS 06243 WALGREENS 07437 WALGREENS 09363 WALGREENS 09606 WAL-MART PHARMACY 10-2668 WAL-MART PHARMACY 10-3488 WHEATON FRANCISCAN HEALTHCAR
Richland
Rock
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Hospital Independent Lab WHEATON FRANCISCAN PHARMACY Pharmacy Physician JOHN M WENTZ, MD Pharmacy RICHLAND FAMILY PRESCRIPTION Independent Lab RICHLAND HOSPITAL Hospital RICHLAND HOSPITAL INC Physician Group RICHLAND MEDICAL CENTER LTD Pharmacy THRIFTY WHITE PHARMACY Pharmacy WAL-MART PHARMACY 10-1007 Pharmacy AURORA PHARMACY INC Federally Qualified Health BELOIT AREA COMMUNITY HEALTH CENTER Clinic (FQHC) Physician Group BELOIT CLINIC Hospital BELOIT MEMORIAL HOSPITAL Independent Lab BELOIT MEMORIAL HOSPITAL INC Physician Group BELOIT RADIOLOGY LTD Pharmacy CUB PHARMACY Page 82 of 114
SFY 2007 $1,244 $17,019 $5,669 $3,086 $3,155 $6,657 $3,624 $1,914 $2,097 $1,697 $2,942 $1,408 $2,812 $1,249 $11 $365 $2,201 $3,710 $31,296 $23,810 $15,108 $104 $19 $1,162
SFY 2008 $857 $14,876 $4,780 $1,183 $3,537 $3,733 $3,934 $8,187 $2,343 $1,015 $1,117 $12,205 $2,829 $1,243 $1,948 $606 $1,537 $2,403 $5,369 $17,338 $13,195 $12,493 $17 $37 $2,161
SFY 2009 $337 $16,086 $5,098 $2,383 $5,200 $9,202 $5,519 $4,515 $1,834 $1,122 $848 $173,227 $5,581 $1,875 $1,467 $98 $1,170 $928 $3,023 $7,469 $12,079 $10,827 $12,211 $32,991 $156 $187
SFY 2010 $327 $18,635 $5,037 $4,615 $7,294 $8,967 $9,928 $15,203 $2,657 $2,042 $1,016 $209,293 $12,024 $3,420 $60 $3,399 $576 $6,863 $3,642 $1,978 $7,427 $11,775 $16,823 $9,192 $83,170 $29 $508
Total $2,765 $66,615 $20,585 $8,181 $19,117 $25,058 $26,039 $31,529 $8,748 $6,276 $4,677 $397,668 $21,841 $9,349 $60 $8,063 $674 $8,650 $6,473 $9,604 $23,976 $72,488 $64,655 $49,004 $116,265 $64 $701 $3,510
Billing Provider Name Billing Provider Type Pharmacy CVS PHARMACY #08534 Pharmacy CVS PHARMACY#08550 Pharmacy CVS PHARMACY#08551 Pharmacy DEAN PHARMACY Hospital EDGERTON HOSPITAL & HEALTH Physician Group EDGERTON HOSPITAL & HEALTH S EDGERTON HOSPITAL MILTON CLINIC Physician Group Pharmacy EDGERTON PHARMACY EVANSVILLE HOMETOWN PHARMACY Pharmacy F FIRST CHOICEWOMENS HEALTH CENTERamily Planning Clinic Physician Group HART ROAD PATHOLOGY SC Pharmacy HOMECARE PHARMACY LLC Pharmacy HOMECARES BELOIT CLINIC Federally Qualified Health JANESVILLE COMMUNITY HEALTH CENTER Clinic (FQHC) Physician Group JANESVILLE MEDICAL CENTER Physician JONAS J Y LEE, MD Pharmacy K MART PHARMACY 4255 Pharmacy KEALEY PHARMACY & HOMECARE Physician KENNETH R BETTS, MD Pharmacy MERCY EAST PHARMACY Hospital MERCY HEALTH SYSTEM CORP Physician Group MERCY HOSPITAL PHYSICIANS Pharmacy MERCY MALL PHARMACY Mental Health and Substance Abuse MERCY OPTIONS BEHAVIORAL HEALTHServices JANESVILLE CLINIC Pharmacy MERCY WEST PHARMACY Physician Group MHS PHYSICIAN SERVICES Page 83 of 114
SFY 2007 $4,632 $523 $280 $880 $52 $1,362 $625 $398,223 $1,024 $1,413 $731 $37 $170
SFY 2008 $7,488 $935 $1,867 $377 $303 $30 $472 $2,187 $393,236 $709 $490 $474 $256 $115 $261 $1,381 $57 $670 $913 $34
SFY 2009 $3,267 $1,631 $2,885 $426 $1,087
SFY 2010 $3,738 $2,292 $172 $1,050 $95 $30 $1,246 $1,472 $472,959 $2,303 $1,057
$1,167 $3,025 $350,072 $1,056 $1,428 $16 $58 $180 $194 $371 $433 $7,296
Total $19,125 $3,090 $7,324 $1,855 $2,440 $177 $30 $4,246 $7,309 $1,614,490 $5,091 $4,387 $1,221 $350 $465 $194 $261 $5,342 $194 $2,279 $30,558 $502 $497
$1,958 $137 $758 $318 $218
$1,631 $419 $22,031 $502 $245
$1,770 $15,973
$1,770 $13,632
$921 $22,386
$48 $624 $50,564
$48 $5,084 $102,554
Billing Provider Name MILTON PHARMACY OSCO DRUG #5035 OSCO DRUG 5089 OSCO DRUG#5087
Rusk
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Ambulatory Surgical Center (ASC) RIVERVIEW SURGERY CENTER ROCK COUNTY HEALTH DEPARTMENT Family Planning Clinic Pharmacy SAM'S PHARMACY 10-4840 Pharmacy SCHNUCKS PHARMACY 758 Pharmacy SHOPKO PHARMACY #2030 Pharmacy SHOPKO PHARMACY 2026 Physician Group ST MARYS DEAN VENTURES INC Physician Group STATELINE ANESTHESIOLOGISTS Pharmacy TARGET STORE T-0809 PHARMACY Pharmacy WAL MART PHARMACY 101305 Pharmacy WALGREENS #04055 Pharmacy WALGREENS #11235 Pharmacy WALGREENS #11236 Pharmacy WALGREENS #11528 Pharmacy WALGREENS #12136 Pharmacy WALGREENS #13613 Pharmacy WALGREENS 06096 Pharmacy WAL-MART PHARMACY 10-2532 Physician Group WEST SIDE MEDICAL CENTER Pharmacy FLAMBEAU PHARMACY Independent Lab MARSHFIELD CLINIC LADYSMITH Federally Qualified Health Clinic (FQHC) MARSHFIELD CLINIC PHARMACY Pharmacy PAMIDA PHARMACY 314 Page 84 of 114
SFY 2007 $880 $1,714 $147 $222
SFY 2008 $1,542
SFY 2009 $498
SFY 2010 $587
Total $3,507 $1,714 $147 $222 $2,178 $214 $684 $7,577 $9,227 $20,080 $4,463 $172 $12,911 $14,902 $51,604 $12,270 $4,800 $6,983 $2,697 $27,898 $55,620 $22,152 $3,980 $6,827 $105 $25,795 $9,352
$119 $954 $1,361 $5,431 $489 $221 $1,744 $8,431
$1,447 $16 $120 $2,571 $1,995 $4,561 $1,114 $1,900 $4,134 $11,289 $2,654
$33 $294 $2,200 $2,427 $5,130 $788 $2,210 $3,218 $15,061 $4,905 $1,450 $2,448 $941 $6,968 $11,144 $8,652 $454 $1,259 $105 $7,455 $1,526
$7,309 $16,809 $1,495 $322 $2,995
$8,163 $15,766 $3,903 $498 $2,573
$731 $164 $151 $1,851 $3,445 $4,959 $2,071 $172 $8,581 $5,805 $16,823 $4,712 $3,350 $4,536 $1,756 $5,458 $11,902 $8,103 $2,706
$6,122 $2,592
$7,267 $1,950
$4,951 $3,284
Sauk
Billing Provider Name Billing Provider Type Pharmacy RUSK CO CLINIC PHCY Family RUSK CO DEPT HEALTH & HUMAN SERVICES Planning Clinic Hospital RUSK COUNTY MEMORIAL HOSP Physician Group RUSK COUNTY MEMORIAL HOSPITA Pharmacy WAL-MART PHARMACY 10-4281 Pharmacy BALLWEG FAMILY PHARMACY INC Pharmacy CORNER DRUG Pharmacy DEAN PHARMACY Physician Group DELTON FAMILY MEDICAL CENTER Physician DIANA L KRUSE, MD Pharmacy EANNELLI PHARMACY Pharmacy HALL PHARMACYINC Physician HISHAM A OSMAN, MD Federally Qualified Health Clinic (FQHC) HOCHUNK NATION WELLNESS Pharmacy HOUSE OF WELLNESS PHARMACY Pharmacy K MART PHARMACY 7650 Pharmacy MAIN STREET PHARMACY INC Pharmacy MEDICAL ARTS PHARMACY Physician MICHAEL D PLOOSTER, MD Physician Group ORTHOPEDIC ASSOCIATES OF Pharmacy PAMIDA PHARMACY 175 Physician Group PLAIN MEDICAL CLINIC Rural Health Clinic Physician Group PRAIRIE CLINIC SC Anesthetist REEDSBURG AREA MEDICAL Hospital Independent Lab REEDSBURG AREA MEDICALCENTE REEDSBURG AREA MEDICALCENTER Physician Group Page 85 of 114
SFY 2007 $1,603 $15,504
SFY 2008 $1,115 $11,105 $183 $941 $560 $3,369 $655 $628 $793 $994 $144 $236 $1,592 $84 $2,949 $90 $403
SFY 2009 $410 $12,022 $520 $3,872 $756 $1,829 $1,775 $741 $335
$316 $2,564 $1,263 $220 $60 $953 $1,046 $149 $345 $149 $1,034 $5,179
SFY 2010 $1,698 $15,114 $2,022 $22 $7,197 $511 $2,543 $1,999 $1,011 $1,485
Total $4,826 $53,746 $2,726 $22 $12,010 $2,143 $10,305 $5,693 $2,600 $60 $3,567 $2,040 $293 $790 $302 $3,838 $178 $16,817 $340 $315 $1,313 $11 $73 $10,632 $440 $30,014 $1,384 $729
$79 $524 $93 $4,335
$130 $154 $688 $4,355 $340 $225 $298 $11 $73 $3,331 $12,854 $640 $414
$613
$3,542 $269 $1,205 $208 $60
$1,941 $2,896 $238 $73
$1,819 $171 $13,058 $297 $181
Sawyer
Billing Provider Name Billing Provider Type Pharmacy REEDSBURG FAMILY PRESCRIPTION CENTER Physician Group REEDSBURG MEMORIAL HOSPITAL Physician Group REEDSBURG PHYSICIANS GROUPSC Physician Group RIVER VALLEY MEDICAL CLINIC Rural Health Clinic RIVER VALLEYMEDICAL CLINIC Pharmacy SAUK CITY PHARMACY SAUK PRAIRIE MEMORIAL HOSPITAL Physician Group Hospital SAUK PRAIRIEMEMORIAL HOSP Rural Health Clinic SPRING GREENMEDICAL CENTER Therapy Group Pharmacy SPRING GREENPHARMACY INC Physician Group SPRING MEDICAL ASSOCIATES LL Hospital ST CLARE HOSPITAL AND HEALTH Physician Group Independent Lab ST CLARE LABORATORY Physician Group ST MARYS DEAN VENTURES INC Physician Group SURGICAL ASSOCIATES Physician Group SURGICAL PARTNERS SC Dentist TIMOTHY J MCREATH, DDS Pharmacy WALGREENS #11277 Pharmacy WALGREENS 06885 Pharmacy WALGREENS 10237 Pharmacy WALGREENS#07882 Pharmacy WAL-MART PHARMACY 10-1396 Pharmacy WAL-MART PHARMACY 10-3505 Pharmacy CO OP PHARMACY DULUTH CLINIC HAYWARD PHARMA Pharmacy ESSENTIA HEALTH HAYWARD CLINIC Physician Group Physician FOGARTY SURGICAL SERVICES & FAMILY CARE Group Page 86 of 114
SFY 2007 $364 $30 $5,910 $97 $462 $431 $78 $2,297 $155 $90 $261 $192 $9,807 $22 $1,166 $2,382 $9,086 $4,205 $3,079 $1,340 $621 $2,956 $6,917 $246
SFY 2008 $287 $7,766 $43 $265 $464 $433 $463 $2,032 $268 $81 $228 $10,077 $112 $30 $159 $5,796 $6,059 $4,595 $1,913 $790 $1,959 $2,272 $7,467 $678
SFY 2009 $713 $4,610
SFY 2010 $981 $6,669 $10 $70 $441 $121 $5,846 $117 $689 $30 $11,819 $1,147 $630 $18,669 $37 $111 $3,512 $6,311 $6,970 $9,465 $3,112 $3,232 $190 $1,868 $10,066 $580
$112 $30 $1,842 $92 $354 $5,345 $61 $238 $9,270 $22 $55 $2,017 $4,768 $4,779 $5,371 $1,761 $1,293 $2,031 $7,961 $175
Total $2,344 $30 $24,955 $10 $210 $1,280 $1,046 $8,121 $658 $92 $5,371 $185 $17,521 $1,549 $1,288 $47,824 $171 $218 $1,166 $5,687 $19,257 $26,894 $23,635 $9,866 $6,655 $2,769 $9,127 $32,411 $1,679
Billing Provider Name HAYWARD AREAMEMORIAL HOSP
Shawano
Billing Provider Type SFY 2007 Hospital $169 Physician Group $158 Independent Lab HAYWARD AREAMEMORIAL HOSPIT Pharmacy INHOFF HEALTH MART PHARMACY $2,032 Federally Qualified Health Clinic (FQHC) LAC COURTE OREILLES $1,259 Mental Health and Substance Abuse Services LAC COURTE OREILLES COMMUNIT Pharmacy PAMIDA PHARMACY #325 $3,329 Family Planning Clinic SAWYER COUNTY HEALTH & HUMAN SERVICES SAWYER COUNT $15,587 Rural Health Clinic STONE LAKE RURAL HEALTH CLIN $122 Pharmacy WALGREENS #11857 Pharmacy WAL-MART PHARMACY 10-3245 $3,054 Physician Group ASPIRUS GENERAL CLINIC $71 Physician Group ASPIRUS WAUSAU HOSPITAL INC WITTENBERG CLINIC Physician Group ASPIRUS WITTENBERG CLINIC Pharmacy DREIER PHARMACY & GIFTSHOPP $950 Physician Group FMC BONDUEL $166 Pharmacy GWIDT PHARMACY INC $1,950 Pharmacy K MART PHARMACY 3769 $272 LANGLADE MEMORIAL HOSPGENERA Physician Group $284 Independent Lab MARSHFIELD CLINIC WITTENBERG Family PLANNED PARENTHOOD OF WISCONSIN, INC Planning Clinic $128,332 Hospital SHAWANO MEDICAL CENTER $252 Physician Group $37 SHAWANO MEDICAL CENTER CLINIC Physician Group $66 Pharmacy STOCKBRIDGE MUNSEE HEALTH & WELLNESS
SFY 2008 $163 $60 $1,761 $2,377
SFY 2009 $1,244 $34 $1,601 $3,467
SFY 2010 $2,177 $53
Total $3,752 $158 $147 $5,394 $8,573
$1,470
$318 $3,734 $13,928 $108 $6,036
$3,767 $10,583 $2,056 $7,873
$3,186 $11,449 $7,276 $11,953 $135 $228 $972 $1,948 $511 $332 $21 $40,441 $10,984 $263 $1,218 $353
$1,290 $3,480 $354 $560 $479,331 $505 $55
$37 $862 $2,721 $274 $69 $138,238 $5,129 $30 $554 $281
$318 $14,017 $51,547 $230 $9,332 $28,916 $71 $135 $265 $4,074 $166 $10,100 $1,412 $1,246 $21 $786,342 $16,870 $330 $1,892 $635
Page 87 of 114
Sheboygan
Billing Provider Type Federally Qualified Health Clinic STOCKBRIDGE MUNSEE HEALTH & WELLNESS CTR (FQHC) Pharmacy THEDACARE PHARMACY THEDACARE PHYSICIANS SHAWANO Physician Group Physician Group THEDACARE PHYSICIANS TIGERTON Pharmacy WALGREENS 07615 Pharmacy WAL-MART PHARMACY 10-2271 Physician Group AURORA MEDICAL GROUP Mental Health and Substance Abuse Services AURORA MEDICAL GROUP INC Pharmacy AURORA PHARMACY INC Hospital AURORA SHEBOYGAN MEMORIAL Physician Group AURORA VALLEY VIEW CAMPUS OF Physician Group COULIS CARDIOLOGY Physician DEAN A MANCHESKI, MD Physician GARY R SCHERR, MD Physician GEORGE S SCHROEDER, MD Pharmacy GLANDER PRESCRIPTIONS PLUS Physician JAMES R PAWLAK, MD Pharmacy K MART PHARMACY 3831 Pharmacy K MART PHARMACY 7100 Physician KATHERINE C CLEVELAND, MD Physician KATHRYN A GREEN, MD Physician LOUIE COULIS, MD Physician Group MARSHO FAMILY MEDICAL GROUP Physician MARY E ARENBERG, MD Physician MARY J GENTINE, MD Nurse Practitioner NAN C BROWNE, NP Page 88 of 114
SFY 2007 $901 $1,580 $3,786 $1,936 $2,724 $15,821
SFY 2008 $165 $1,495 $6,693 $481 $2,999 $3,144 $9,955
SFY 2009 $955 $771 $2,292 $2,621 $5,200 $11,442
SFY 2010 $1,860 $916
Total $3,880 $4,762 $12,770 $481 $10,831 $16,917 $62,894
$3,275 $5,851 $25,676
$5,148 $163 $189 $59 $79 $57 $88 $518 $321
$4,493 $484
$7,397 $5,021
$11 $8,668 $2,881 $61
$115
$183 $589 $255 $102
$115 $60 $1,004 $383 $48
$598 $427 $409
$127 $2,136 $648 $30 $22 $30 $37
$11 $25,706 $8,549 $189 $120 $115 $79 $57 $983 $60 $2,537 $1,368 $48 $102 $127 $2,166 $670 $30 $37
St. Croix
Billing Provider Name Billing Provider Type Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician Group PLYMOUTH FAMILY PHYSICIANS Physician Group PREVEA SHEBOYGAN HEALTH CENT Physician SCOTT M STILLWELL, MD Physician SHEBOYGAN INTERNAL MEDICINE ASSOCIATES Group Physician Group SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC Physician Group SHEBOYGAN WOMENS HEALTH SC Pharmacy SHOPKO PHARMACY #2116 Physician Group SHORELINE SKIN SPECIALISTS Physician Group ST MARYS HOSPITAL OZAUKEE Hospital ST NICHOLAS HOSPITAL Independent Lab Physician STEVEN J STAEHLING, MD Pharmacy TARGET STORE T-1880 PHARMACY Physician THOMAS J ZWEIFEL, DO Pharmacy WALGREEN 06097 Pharmacy WALGREENS #12020 Pharmacy WALGREENS 01497 Pharmacy WALGREENS06570 Pharmacy WAL-MART PHARMACY 10-1276 Pharmacy WAL-MART PHARMACY 10-3324 Pharmacy WAL-MART PHARMACY 10-3497 BALDWIN AREA MEDICAL CENTER INC Hospital Independent Lab BALDWIN AREAMEDICAL CENTER Physician Group Rural Health Clinic BALDWIN CLINIC COMMUNITY PHARMACY AT HUDSON Pharmacy Pharmacy COUNTY MARKET PHARMACY Pharmacy ECONOFOODS PHARMACY #320 Page 89 of 114
SFY 2007 $186,199
SFY 2008 $198,025
SFY 2009 $193,104 $1,214 $73 $88
SFY 2010 $329,532 $79 $2,649 $511 $454 $1,488 $153 $19,586 $573 $1,074 $122 $4,212 $5,910 $4,227 $9,098 $2,798 $2,899 $3,189 $5,970 $87 $155 $4,873 $1,340 $183
$67 $2,558 $676
$2,084 $227 $421 $260 $793 $1,827 $2,767 $953 $2,680 $9,762 $4,515 $100 $1,805 $631 $30 $3,536 $484 $65 $1,426 $1,651 $1,995 $2,225 $10,129 $2,959 $2,437 $1,445 $3,951 $22 $4,642 $868 $452
$183 $951 $1,780 $3,838 $1,889 $1,474 $8,012 $1,893 $1,252 $315 $103 $1,604 $1,308 $536 $135
$868 $1,048 $773
Total $906,860 $79 $3,862 $73 $599 $521 $4,642 $2,391 $153 $451 $23,565 $2,801 $65 $6,106 $122 $12,468 $10,748 $10,606 $37,001 $12,166 $5,436 $7,691 $10,867 $109 $258 $11,987 $4,565 $1,944 $135
Taylor
Billing Provider Name Billing Provider Type Pharmacy ECONOFOODS PHARMACY #321 Pharmacy ECONOFOODS PHARMACY 344 Physician EILEEN M REARDON, MD Physician Group HUDSON HOSPITAL & CLINICS Hospital HUDSON HOSPITAL INC Anesthetist HUDSON MEMORIAL HOSPITAL Physician Group HUDSON PHYSICIANS Nurse Practitioner MARJORIE J BELISLE, NP Pharmacy MICKLESEN DRUG INC Physician Group NEW RICHMONDCLINIC Pharmacy PAMIDA PHARMACY 315 Pharmacy SHOPKO PHARMACY #2130 Pharmacy SOMERSET DRUG LLC Family Planning Clinic ST CROIX CO HEALTH & HUMAN Nurse Practitioner STEPHANIE L JOHNSON, CNM Physician Group STILLWATER MEDICAL GROUP Pharmacy TARGET STORE T-1235 PHARMACY Pharmacy VILLAGE PHARMACY Pharmacy WALGREENS #10585 Pharmacy WAL-MART PHARMACY 10-1365 Pharmacy WAL-MART PHARMACY 10-5432 Physician Group WESTERN WISCONSIN OB GYN Hospital WESTFIELDS HOSPITAL Physician Group WESTFIELDS HOSPITAL INC Pharmacy K MART PHARMCY 7656 Pharmacy MEDFORD VALURITE DRUGS Pharmacy MEDICAL CENTER PHARMACY Physician MEMORIAL HEALTH CENTER CLINIC RIB LAKE Group Physician MEMORIAL HEALTH CENTER CLINICS GILMAN Group Page 90 of 114
SFY 2007 $5,186 $1,052 $47 $715 $2,386 $77 $940 $2,621 $2,603 $2,117 $134,347 $338 $114 $3,232 $2,715 $507 $1,761 $2,385 $881
SFY 2008 $4,720 $405 $475 $4,050 $143 $3,902 $60 $682 $3,309 $485 $1,873 $122,823 $223 $290 $2,833 $4,606 $3,964 $2,568 $3,144 $755 $1,665 $2,601 $2,987 $3,486 $415 $147
SFY 2009 $3,415 $169 $130 $14,888 $4,953 $55 $119 $3,329 $872 $394 $134,667 $436 $3,033 $7,148 $6,431 $2,701 $6,278 $4,035 $58 $1,250 $1,822 $3,980 $157 $1,414
SFY 2010 $3,877 $1,792 $37 $17,405 $6,062 $496 $4,074 $2,233 $960 $252,243 $1,199 $5,696 $8,923 $9,546 $4,967 $8,856 $9,079 $257 $1,020 $1,421 $5,416 $297 $344
$2,073 $3,553 $4,637 $100
Total $17,198 $3,419 $652 $37 $37,057 $143 $17,304 $192 $2,237 $13,332 $3,088 $7,095 $1,354 $644,080 $560 $2,039 $14,795 $23,393 $20,447 $11,996 $20,662 $1,636 $14,779 $314 $6,944 $9,783 $17,518 $869 $2,005
Trempealeau
Vernon
Billing Provider Type SFY 2007 Mental Health and Substance Abuse Services MEMORIAL HEALTH CENTER CLINICS MEDFORD BEHAVIORAL Physician Group MEMORIAL HEALTH CENTERCLINI $4,091 Hospital MEMORIAL HEALTH CENTERINC $2,572 Independent Lab $716 Physician Group $276 Pharmacy WAL-MART PHARMACY 10-3643 Pharmacy COLBY HEALTHMART PHARMACY $492 Hospital FRANCISCAN SKEMP ARCADIA Pharmacy GALESVILLE PHARMACY $140 Rural Health Clinic GUNDERSEN CLINIC BLAIR Rural Health Clinic GUNDERSEN CLINIC INDEPENDENC $39 Physician Group GUNDERSEN CLINIC LTD Rural Health Clinic GUNDERSEN CLINIC WHITEHALL $441 Hospital MAYO CLINIC HEALTH SYSTEM OAKRIDGE INC Physician Group MAYO CLINIC HEALTH SYSTEM OAKRIDGE- OSSEO CLINIC $85 Pharmacy MAYO CLINIC HEALTH SYSTEM PHARMACY & HOME MEDICAL $223 Pharmacy PAMIDA PHARMACY 834 $674 Pharmacy STRUM PHARMACY INC $246 Pharmacy THE BLAIR PHARMACY $508 Physician Group TRI COUNTY MEMORIAL $30 Hospital TRI COUNTY MEMORIAL HOSPITAL $99 Independent Lab Family Planning Clinic WESTERN DAIRYLAND ECONOMIC OPPORTUNITY COUNCIL INC $34,675 Rural Health Clinic BLAND CLINICVMH $139 Rural Health Clinic GUNDERSEN CLINIC HILLSBORO Physician Group GUNDERSEN CLINIC LTD $986 Physician Group HIRSCH CLINIC VMH $548 Page 91 of 114
SFY 2008
SFY 2009
SFY 2010
Total
$3,262 $746 $825 $143 $527 $599 $165 $818 $32 $82 $313 $75 $497 $430 $155 $288 $199 $10 $62,308
$3,881 $10,933 $1,186 $35 $2,050 $793 $110 $1,664 $83 $166 $240 $37 $255 $383 $231 $359 $304 $745 $204 $74,787 $238 $1,003 $134
$115 $5,652 $11,399 $861 $65 $1,154 $1,335 $2,759 $1,109 $201 $148 $248 $1,081 $553 $268 $298 $59 $3,356 $93,500 $108 $109 $33 $406
$916 $10
$115 $16,885 $25,650 $3,587 $518 $3,731 $3,218 $3,034 $3,731 $284 $386 $321 $1,038 $255 $1,624 $1,504 $1,731 $1,003 $1,600 $30 $3,858 $10 $265,271 $486 $109 $2,937 $1,098
Vilas
Walworth
Billing Provider Name Billing Provider Type Rural Health Clinic HIRSCH CLINICVMH Rural Health Clinic LAFARGE MEDICAL CLINIC Pharmacy PETERSON PHARMACY INC Physician Group ST JOSEPHS HEALTH SERVICES INC Hospital ST JOSEPHS MEMORIAL HOSPITAL Hospital VERNON MEMORIAL HOSPITAL Pharmacy VERNON MEMORIAL PHARMACY Pharmacy WALGREENS 10301 Pharmacy WAL-MART PHARMACY 10-0971 Pharmacy WESTBY PHARMACY Physician Group ASPIRUS LAND O LAKES CLINIC Pharmacy ASPIRUS PHARMACY Physician Group ASPIRUS PHELPS CLINIC Hospital EAGLE RIVER MEMORIAL HOSPITAL Pharmacy LAND O LAKESHEALTH CARE PHARMACY Independent Lab MARSHFIELD CLINIC EAGLE RIVE Federally Qualified PETER CHRISTENSEN HEALTH CENTER Health Clinic (FQHC) Pharmacy PETER CHRISTENSEN HLTHCTR Pharmacy RIVER NORTH PHARMACY ST GERMAIN HEALTH CAREPHARMA Pharmacy Physician TERRANCE D MOE, MD Pharmacy TRIGS PHARMACY Family Planning Clinic VILAS COUNTYHEALTH Pharmacy WALGREENS #12545 Pharmacy WALL STREET HEALTH CARE PHAR Physician Group ALTERNATIVE HEALTHCAREFAMIL Hospital AURORA LAKELAND MEDICAL CTR Physician Group AURORA MEDICAL GROUP Page 92 of 114
SFY 2007 $2,916 $246 $823 $360 $155 $1,270 $2,490 $134 $83 $128
SFY 2008 $1,195 $503 $1,746 $235 $740 $918 $42 $2,367 $1,642 $69 $154 $24 $678 $155
SFY 2009 $763 $760 $436 $459 $3,883 $2,770 $1,944 $48
SFY 2010 $1,627 $121 $477 $431 $5,397 $3,348 $4,936 $1,112 $118 $22 $4,712 $769 $11 $1,615 $1,308 $700 $550 $2,329 $2,123 $552 $775 $5,733 $8,364
$1,155
$802 $664
Total $6,501 $870 $3,806 $1,462 $6,596 $8,304 $42 $11,343 $7,188 $134 $318 $282 $46 $6,192 $2,742 $11 $10,106 $1,678 $1,856 $1,636 $1,139 $9,895 $18,145 $2,123 $2,759 $924 $11,599 $18,939
$4,480 $800 $513 $469 $3,105 $18,145 $1,512 $169 $5,302
$1,665 $705 $304 $120 $2,893
$2,347 $370 $351 $119 $1,567
$389 $368 $3,295
$306 $148 $5,328 $1,978
Washburn
Billing Provider Name Billing Provider Type Pharmacy AURORA PHARMACY INC Physician CLIFFORD R POPLAR, MD Physician Group DARIEN MEDICAL CENTER Pharmacy E A MCCULLOUGH INC Physician Group FORT HEALTHCARE INC Dentist JOHN P HOWLAND, DDS Physician JULIE R OSBORNE, DO Physician KAMAL S MUZAFFAR, MD Pharmacy MC 5 INC Pharmacy MCCULLOUGH PHARMACY INC Hospital MERCY WALWORTH HOSPITAL AND MEDICAL CENTER Pharmacy MERCY WALWORTH PHARMACY Physician NEIL J RENNICK, DO Pharmacy PHARMACY STATION Family PLANNED PARENTHOOD OF WISCONSIN, INC Planning Clinic Pharmacy PLAZA PHARMACY Pharmacy REYNOLDS PHARMACY INC Pharmacy SHOPKO PHARMACY #2127 Pharmacy TARGET STORE T-2348 PHARMACY UNIVERSITY HEALTH & COUNSELING Family Planning Clinic Pharmacy WALGREENS #09210 Pharmacy WALGREENS #10714 Pharmacy WALGREENS #12638 Pharmacy WALGREENS 05600 Pharmacy WAL-MART PHARMACY 10-0910 Pharmacy WAL-MART PHARMACY 10-3247 Physician Group ESSENTIA HEALTH SPOONER CLINIC Hospital INDIANHEAD MEDICAL CENTER Physician KATHERINE E PARKINSON, MD Page 93 of 114
SFY 2007 $623 $201 $149
SFY 2008 $352 $30
SFY 2009 $203
SFY 2010 $2,825 $55
$58 $310 $186 $279 $1,849 $199 $51 $416 $670 $1,000 $1,263 $1,336 $96 $62,285 $1,202 $67 $5,588 $1,364 $1,808 $6,687 $624 $30 $1,541 $578 $12 $764 $30 $1,581 $2,466 $365 $2,897 $1,301 $107,318 $949 $1,897 $7,939 $4,251 $2,305 $1,490 $7,849 $4,104 $30 $41 $209 $820 $148 $10,766 $1,078 $2,674 $37,088 $1,683 $1,600 $124 $92,188 $2,829 $4,723 $26,834 $7,341 $4,637 $2,093 $17,471 $323
$254 $633 $727 $57 $2,207 $431 $188 $1,650 $2,870 $1,907
$4,443 $1,427 $1,863 $5,203 $244
Total $4,003 $85 $201 $149 $58 $496 $350 $209 $4,464 $1,558 $10,829 $2,984 $87 $7,132 $39,554 $1,796 $6,031 $5,888 $220 $264,660 $6,886 $6,688 $34,772 $21,623 $9,733 $7,256 $37,209 $5,295 $30
Washington
Billing Provider Type Federally Qualified NORTH WOODS COMMUNITY HEALTH Health Clinic (FQHC) Physician Group Physician Group PARKINSON DERMATOLOGY SC Pharmacy RED CROSS PHARMACY Pharmacy SCHMITZS ECONOMART Physician Group SHELL LAKE CLINIC LTD Pharmacy SHELL LAKE PHARMACY Hospital SPOONER HEALTH SYSTEM Family Planning Clinic WASHBURN COUNTY HEALTHDEPT AURORA HEALTH CENTER HARTFOR Physician Group Hospital AURORA MEDICAL CENTER OF Pharmacy AURORA PHARMACY INC Physician DIAGNOSTIC SERVICES OFWASHINGTON CTY Group Physician DIRK H STEINERT, MD Physician EARL W NEPPLE, MD Pharmacy JEWEL OSCO 3625 Pharmacy K MART PHARMACY 3534 Pharmacy K MART PHARMACY 9645 Physician Group KETTLE MORAINE ANESTHESIOLOG Physician PAUL V BULLIS, MD Pharmacy PICK N SAVE PHARMACY #6417 Pharmacy PICK N SAVE PHARMACY #6430 Pharmacy PICK N SAVE PHARMACY 6357 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Pharmacy SHOPKO PHARMACY #2018 Hospital ST JOSEPHS COMMUNITY HOSP Independent Lab ST JOSEPHS COMMUNITY HOSPITA Physician Group ST MARYS HOSPITAL OZAUKEE Page 94 of 114
SFY 2007 $2,976 $807 $6,919 $1,172 $2,941 $1,384 $45,133 $3,965 $4,925 $1,790
SFY 2008 $2,462
SFY 2009 $2,400
SFY 2010 $2,221 $149 $11,094 $1,330 $2,340 $3,825 $4,282 $30,279 $8,753 $3,299 $3,371 $1,235 $48
Total $10,059 $807 $149 $32,154 $6,457 $11,560 $9,639 $7,798 $122,212 $22,739 $6,168 $13,997 $5,410 $49 $48 $128 $3,389 $208 $127 $30 $1,153 $2,795 $1,201 $796,643 $9,584 $36,274 $10,730 $642
$7,706 $1,835 $3,462 $2,032 $962 $29,543 $6,885 $455 $2,914 $783
$6,435 $2,121 $2,817 $2,398 $2,554 $17,258 $3,136 $2,413 $2,788 $1,603 $49
$128 $2,081 $208
$629 $29
$237
$442 $98
$30 $995 $316 $323,006 $1,992 $1,424 $1,459 $138 $581 $357 $255,541 $2,289 $2,184 $1,886 $330 $775 $162 $78,854 $1,634 $12,496 $3,322 $174 $1,153 $445 $366 $139,241 $3,669 $20,170 $4,063
Waukesha
Billing Provider Name Billing Provider Type Pharmacy WAL MART PHARMACY 10 1515 Pharmacy WAL MART PHARMACY 10 2658 Pharmacy WALGREENS #11676 Pharmacy WALGREENS #13088 Pharmacy WALGREENS 05427 Pharmacy WALGREENS 06960 Physician Group WEST BEND CLINIC INC Pharmacy WEST BEND PHARMACY Physician Group AFFILIATED DERMATOLOGISTS Physician Group ALEXANDER A ROMASHKO MD SC Physician Group AMERIPATH MILWAUKEE SC Physician Group ANEX SC Physician ANN M TOUSIGNANT, MD Physician ANNE M RIENDL, MD Physician ANTHONY HOANG, MD Physician ARNAVAZ DUA, MD Physician Group AURORA HEALTH CENTER Physician Group AURORA MEDICAL GROUP Pharmacy AURORA PHARMACY Pharmacy AURORA PHARMACY INC Nurse Practitioner AURORA QUICKCARE LLC Physician Group AURORA ST LUKES NEW BERLIN AURORA WILKINSON MEDICAL CLINIC Physician Group BELLIN ANESTHESIA ASSOCIATES SC Physician Group Physician BRIAN A CHAPMAN, MD Physician Group BROOKFIELD SURGICAL ASSOC Physician Group CENTER FOR NEUROLOGICAL DISORDERS Nurse Practitioner CHERRI A SCHLEICHER, FNP Physician Group CHILDRENS MEDICAL GROUP Page 95 of 114
SFY 2007 $419 $3,654 $7,917 $3,593 $4,863 $9,095 $174
SFY 2008 $1,564 $5,489 $218 $9,277 $1,685 $5,500 $13,658 $445
SFY 2009 $1,283 $2,850 $1,249 $12,325 $3,402 $4,484 $17,675 $495 $98
$11 $193 $476 $57 $20 $276 $360 $2,064 $60 $1,905
$205 $55 $58
SFY 2010 $4,031 $5,041 $2,080 $18,040 $5,857 $3,614 $38,763 $1,457 $673 $141 $40 $55
$60 $909 $914 $5,548 $505 $2,570 $37
$48 $210 $189 $28 $2,358 $715 $22 $1,052 $111
$78
$1,423 $3,517 $1,427 $2,527 $1,565 $596 $12,505 $55 $182 $266 $48 $148 $33
Total $7,296 $17,035 $3,547 $47,559 $14,538 $18,460 $79,192 $2,570 $770 $141 $256 $304 $58 $476 $57 $48 $1,714 $4,891 $2,730 $12,496 $2,785 $678 $18,032 $203 $182 $266 $126 $148 $33
Billing Provider Name CHRISTINA TINGUELY, MD CHRISTOPH KING, DO CHRISTOPHER J HUSSUSSIAN, MD COMMUNITY MEMORIAL HOSPITAL CVS PHARMACY # 06855 CVS PHARMACY #08947 CVS PHARMACY#08764 DANA J AKIYA, MD DARRYL M PRINCE, MD DERMATOPATHOLOGY OF WISC DIGESTIVE DISEASE SPECIALIST DONALD J LANDGRAF, DO DR ARNAVAZ DUA MD SC ELAINE M LIVERMAN, MD ELDON J SWENSON, MD ELIZABETH M DAVIES, MD ELMBROOK INTERNAL MED ASSOC EMILY E STODDARD, MD FALLS ANESTHESIA ASSOCIATES SC GASTROENTEROLOGY SPECIALISTS GENEVIEVE M JONES, MD GREAT LAKES RADIOLOGISTS GREATER MILWAUKEE PLASTIC SU GREG HEAL, MD GUILLERMO D VARONA, MD HEALTH CENTER PHARMACYWEST JAMES A STADLER II, MD JEROME DRUGS BIG BEND JEROME DRUGS INC
Billing Provider Type Physician Physician Physician Hospital Pharmacy Pharmacy Pharmacy Physician Physician Independent Lab Physician Group Physician Physician Group Physician Physician Physician Physician Group Physician Physician Group Physician Group Physician Physician Group Physician Group Physician Physician Pharmacy Physician Pharmacy Pharmacy Page 96 of 114
SFY 2007
SFY 2008
SFY 2009 $55
$129
$762
$7,165
SFY 2010 $272 $30 $30 $22,723 $59 $26 $325 $61 $2,599 $61 $217 $143
$283 $114 $155 $60
$296
$195 $47 $115 $158 $30
$66 $91
$78 $24
$125 $203 $149
$513 $521 $312 $101 $48 $101 $30 $30 $391 $205 $306
$193
$10 $30 $331 $165 $120 $242 $60
$84 $12 $211 $350
$20 $279
Total $327 $30 $30 $30,780 $59 $26 $579 $325 $175 $3,014 $152 $324 $143 $115 $158 $747 $521 $227 $655 $101 $48 $94 $113 $332 $30 $1,072 $390 $399 $547
Billing Provider Name JOHN E KELLY, MD JOHN R PHILLIPS, MD JOHN S CANTIERI, MD JOSE S AGPOON, MD JUAN T BIAGTAN, MD K MART PHARMACY 3692 K MART PHARMACY 4376 KATHY HARTKE, MD KENNETH G CONDON, MD KENNETH W REICHERT II, MD LABORATORY PATHOLOGY LABWORKS INC LAKE AREA PHYSICAL MEDICINE LAKE COUNTRY PATHOLOGISTS SC LAKE COUNTRYINSTITUTIONAL LAKESHORE MEDICAL CLINIC LAURA EPPERSON, MD LEIF E ESBENSEN, MD LIFETIME OB GYN LTD LYNN K DIULIO, MD MARK A WEBER, MD MARK D GROSSKLAUS, MD MARY C FOX, MD MARY M MILBRATH, MD MATTHEW A MEYER, MD MEDICAL ASSOCIATES INC MEDICAL CENTER PHARMACY MEDICAL EYE ASSOC S C
Billing Provider Type Physician Physician Physician Physician Physician Pharmacy Pharmacy Physician Physician Physician Physician Group Physician Group Physician Group Physician Group Pharmacy Physician Group Physician Physician Physician Group Physician Physician Physician Physician Physician Physician Physician Group Pharmacy Physician Group
SFY 2007 $129 $99
SFY 2008 $163
SFY 2009
$135
$524 $109 $19
$1,190 $282 $57
SFY 2010 $296 $22 $59 $98 $126 $502
$55 $22 $104 $30 $39 $29 $87 $12 $90 $721 $57 $43 $1,260 $457 $218 $2,782 $273 $3,725 $2,932 $257 $410 $7,571 $58 $43 $30 $22 $354 $9,337 $65 $153
$1,457 $176
$981
$3,961
$2,987
$290 $1,949 $323
Total $588 $22 $158 $98 $126 $2,216 $526 $75 $55 $22 $104 $12 $436 $5,745 $29 $3,532 $475 $410 $12,791 $58 $176 $43 $30 $22 $645 $18,233 $388 $153
Page 97 of 114
Billing Provider Type Ambulatory Surgical Center (ASC) MENOMONEE FALLS ASC Pharmacy MENOMONEE FALLS MEDICAL Physician Group METROPOLITAN ANESTHESIOLOGISTS SC Physician MICHAEL LUNDE, MD Physician Group MIDWEST PHYS ANES SRVCS SC Pharmacy MILLER PHARMACY INC Physician MILWAUKEE ANESTHESIA CONSULTANTS LTD Group Physician MOHAMMED R SETHI, MD Independent Lab MORELAND MEDICAL CENTER LAB MORELAND OB/GYN ASSOCIATES, S.C. Physician Group Pharmacy MORELAND PLAZA PHARMACY INC Physician Group NEURO ASSOC WAUKESHA LTD Pharmacy NEW BERLIN PHARMACY INC Physician NEZIH Z HASANOGLU, DO Physician NICOLE L STERNITZKY, MD Physician Group NORTHWOODS ANESTHESIA SERVICES SC Physician Group OB GYN AFFILIATES SC Hospital OCONOMOWOC MEM HOSP OCONOMOWOC MEMORIAL HOSPITAL Independent Lab Physician Group ORTHOPAEDIC ASSOCIATES OF WI Pharmacy OSCO DRUG #3680 Physician Group PADMAJA DONIPARTHI MD SC Dentist PAMELA R HANSON, DDS Physician PATRICIO F VIERNES, MD Pharmacy PICK N SAVE PHARMACY #6312 Pharmacy PICK N SAVE PHARMACY #6315 Pharmacy PICK N SAVE PHARMACY #6369 Pharmacy PICK N SAVE PHARMACY #6384 Page 98 of 114
SFY 2007 $724 $166 $157
SFY 2008
SFY 2009
SFY 2010 $731
Total $1,455 $276 $332 $48 $30 $2,908 $153 $78 $869 $9,785 $34 $164 $629 $113 $2,000 $233 $569 $17,730 $2,619 $504 $232 $171 $1,063 $48 $152 $389 $392 $44
$111 $176 $48 $30 $627
$1,362 $78 $11 $1,359
$487
$433 $153 $309 $3,851 $164 $259 $113 $291 $196 $280 $11,548 $984 $430 $171
$220 $2,345
$329 $2,231 $34 $370
$1,032 $37 $57 $298 $520 $73 $232 $680 $47
$299 $129 $904 $561
$378 $103 $4,979 $554
$383 $48 $105 $389 $392 $44
Billing Provider Name Billing Provider Type Pharmacy PICK N SAVE PHARMACY #6386 Pharmacy PICK N SAVE PHARMACY #6397 Pharmacy PICK N SAVE PHARMACY #6413 Pharmacy PICK N SAVE PHARMACY #6853 Pharmacy PICK N SAVE PHARMACY #6881 Pharmacy PICK N SAVE PHARMACY 6308 Pharmacy PICK N SAVE PHARMACY 6388 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician Group PRACTICE MANAGEMENT GROUP Pharmacy PRESCRIPTIONCENTER Physician Group PROHEALTH CARE MEDICAL ASSOCIATES Physician Group PROHEALTH CARE MEDICALCTRS Physician Group RADIOLOGY WAUKESHA SC Physician RALPH T COMPTON III, MD RENEU WOMENSHEALTH ANDMEDIS Physician Group Physician RICHARD J POLLACK, DO Physician Group RIESCH SURGICAL SCIENCE LLC Physician ROBERT E SCHELLINGER, MD Physician ROGER A LALICH, DO Pharmacy SAM'S PHARMACY 10-8164 Physician SEAN A JOCHIMS, MD Physician SHEKHAR A DAGAM, MD Physician SHERRY L PROWATZKE, MD Pharmacy SHOPKO PHARMACY #2178 SOUTHEASTERN WI ANESTHESIOLOGY Physician Group Physician STANYA SMITH, MD Pharmacy STONES PHARMACY INC Physician Group SUSSEX FAMILY PRACTICESC Pharmacy TARGET STORE T-0863 Page 99 of 114
SFY 2007
SFY 2008
SFY 2009
SFY 2010 $31 $88 $200
Total $31 $88 $418 $200 $327 $282 $8,053 $1,413,354 $2,167 $1,683 $32,638 $231 $1,077 $13 $670 $257 $61 $744 $310 $547 $30 $48 $58 $483 $585 $170 $167 $605 $2,355
$418 $327 $100 $1,235 $364,937 $115 $32 $3,582
$56 $1,585 $439,532 $112 $4,401 $157 $246
$126 $2,317 $606,713 $113 $5,900 $136 $13 $44
$2,916 $2,171 $1,827 $1,651 $18,754 $231 $785 $380 $257 $61 $678 $273 $298
$67 $160 $30 $48 $37 $89
$58 $483 $223 $176 $186 $170 $167 $393 $137 $181 $1,007 $468 $773
Billing Provider Name TARGET STORE T-0864 PHARMACY TARGET STORE T-1311 PHARMACY TARGET STORE T-2546 PHARMACY TARGET T-0082 PHARMACY THEODORE G GREEN, DO THOMAS G KORKOS MD SC THOMAS G KORKOS, MD THOMAS G WITTMANN, MD TIMOTHY G MCAVOY, MD TOBIN DRUG OCONOMOWOC INC UROLOGY ASSOCIATES LTD SC VERRE YOUNG EYE CLINICSC VICTORIA J MONDLOCH, MD WAL MART PHARMACY 10 1515 WALGREEN 07259 WALGREENS #03615 WALGREENS #05309 WALGREENS #11636 WALGREENS 02752 WALGREENS 03567 WALGREENS 04672 WALGREENS 04888 WALGREENS 05002 WALGREENS 05281 WALGREENS 05466 WALGREENS 05636 WALGREENS 07039 WALGREENS 07143 WALGREENS 07603
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Physician Physician Group Physician Physician Physician Pharmacy Physician Group Physician Group Physician Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Page 100 of 114
SFY 2007 $280
SFY 2008 $309 $313
SFY 2009 $22 $1,171 $297
SFY 2010 $1,692 $1,507 $488 $274 $48 $55 $169 $30
$22
$22 $55 $144
$55 $48 $173 $626 $1,006 $971 $1,484 $215 $1,801 $1,283 $1,357 $3,078 $1,734 $651 $2,167 $1,239 $114 $1,404 $1,109 $926 $1,489 $366 $815 $3,117 $1,312 $1,149 $3,171 $2,112 $1,423 $3,216 $1,667 $652 $1,633 $1,532 $619 $709 $254 $842 $2,006 $206 $1,208 $2,642 $1,005 $1,636 $2,540 $2,986 $829 $1,193 $2,609 $756 $1,702 $1,925 $3,683 $3,737 $1,807 $821 $4,895 $2,107 $1,846 $2,306 $3,461 $209 $1,568
Total $1,714 $3,267 $488 $885 $22 $48 $55 $190 $85 $144 $55 $48 $173 $626 $6,255 $3,272 $5,384 $2,545 $5,555 $10,662 $4,609 $4,536 $13,786 $6,958 $5,555 $10,229 $9,353 $1,804 $5,798
Waupaca
Billing Provider Name WALGREENS 07731 WALGREENS 09365 WALGREENS#03883 WALGREENS#07797 WALGREENS07730 WAL-MART PHARMACY 10-1571 WAL-MART PHARMACY 10-1635 WAL-MART PHARMACY 10-1678 WAL-MART PHARMACY 10-3322 WAL-MART PHARMACY 10-5438 WAUKESHA COUNTY HEALTH& WAUKESHA FAMILY PRACTICE CEN WAUKESHA HEART INSTITUTE WAUKESHA MEMORIAL HOSPITAL INC WAUKESHA MEMORIAL HOSPITAL L WAUKESHA PEDIATRIC ASSOCIATE WAUKESHA PHARMACY WAUKESHA SURGICAL SPECIALIST WEST SUBURBAN CENTER FOR WESTWOOD MEDICAL GROUP WHEATON FRANCISCAN INC WHEATON FRANCISCAN MEDICAL WHEATON FRANCISCAN PHARMACY WILLIAM A DARLING, MD WISCONSIN EATING DISORDER WISCONSIN HEART GROUP SC WISCONSIN NEUROSURGERY SC WOMENS HEALTHCARE SC AFFINITY MEDICAL GROUPRHC
Billing Provider Type Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physician Group Physician Group Physician Group Hospital Independent Lab Physician Group Pharmacy Physician Group Physician Group Physician Group Hospital Physician Group Pharmacy Physician Physician Group Physician Group Physician Group Physician Group Rural Health Clinic Page 101 of 114
SFY 2007 $3,265 $1,328 $3,052 $340 $1,000 $860 $1,167 $1,270 $862
SFY 2008 $2,396 $2,076 $6,714 $391 $3,316 $1,218 $599 $1,402 $274 $288 $159 $2,252 $3,170 $77
SFY 2009 $1,581 $1,810 $5,178 $779 $1,500 $2,518 $492 $2,050 $1,058 $787 $686 $30,323 $3,692
$70 $446 $2,362 $30
$254 $91 $48
$4,393
SFY 2010 $1,520 $5,529 $5,137 $852 $2,024 $2,333 $1,926 $1,145 $507 $1,107 $101 $3,455 $30 $74,153 $15,848 $57 $75 $74 $101 $193 $14,364 $14 $30
$94 $101 $60 $909 $337 $314 $143 $88 $505
Total $8,763 $10,743 $20,081 $2,361 $7,840 $6,929 $4,185 $5,866 $2,701 $2,181 $101 $4,370 $30 $107,174 $25,072 $164 $75 $74 $101 $193 $19,010 $91 $62 $30 $94 $101 $60 $1,223 $1,073
Billing Provider Name ELIZABETH A BARON-KUHN, MD JOHN G HOFFMANN, MD K MART PHARMACY 3750 KOEPPENS MEDICAL TRANSPORTS MINISTRY MEDICAL GROUP MINITSTRY MEDICAL GROUP PAMIDA PHARMACY 220 PRESCRIPTIONS PLUS RICHARD S VEIGA MD SC RICHARD S VEIGA, MD RIVERSIDE CLINIC PHARMACY RIVERSIDE MEDICAL CENTER
Waushara
Billing Provider Type Physician Physician Pharmacy Transportation Physician Group Physician Group Pharmacy Pharmacy Physician Group Physician Pharmacy Hospital Independent Lab Physician Group Physician ROBERT L PETERSON, MD Pharmacy STRATTON DRUGINC Pharmacy THE MEDICINESHOPPE Physician Group THEDACARE PHYSICIANS CLINTONVILLE Physician Group THEDACARE PHYSICIANS IOLA THEDACARE PHYSICIANS WAUPACA Physician Group Physician TIMOTHY B RASOR, MD Pharmacy WALGREENS #09699 Pharmacy WALGREENS #11301 Pharmacy WAL-MART PHARMACY 10-1471 Family Planning Clinic WAUPACA COUNTY DHHS Pharmacy WAUPACA WOODS PHARMACY Pharmacy AURORA PHARMACY INC CHN MEDICAL CENTER REDGRANITE Physician Group Physician Group CHN MEDICAL CENTER WAUTOMA Page 102 of 114
SFY 2007 $628 $1,475
SFY 2008
SFY 2009
SFY 2010 $301 $2,880 $1,516 $465 $4,460 $368 $358 $914 $11,164 $827 $256 $2,461
$1,956 $88
$1,202 $394 $30 $2,916 $310
$3,399 $680 $630 $1,212 $571 $661 $112 $22 $1,460 $223
$2,681 $486 $433 $1,926 $2,891 $322 $52 $948 $32 $114 $1,872 $87 $6,316 $150 $2,167 $26,868 $855 $794 $86
$1,852 $18,721 $293 $201 $1,644
$1,881 $5,885 $2,535 $55,993 $858 $764 $30
$1,870 $1,611 $9,978 $2,948 $1,993 $80,446 $1,288 $3,888
$59 $6,753 $8,490 $3,114 $1,246 $66,804 $982 $1,813 $216 $342
Total $628 $301 $7,513 $88 $1,910 $495 $13,456 $1,845 $358 $1,063 $5,905 $33,348 $2,103 $620 $22 $6,514 $255 $114 $1,929 $12,117 $87 $30,669 $6,211 $7,941 $230,112 $3,983 $7,259 $332 $342
Billing Provider Name CHN PHARMACY #1
Winnebago
Billing Provider Type Pharmacy Federally Qualified Health Clinic (FQHC) LA CLINICA DE LOS CAMPESINOS Pharmacy PAMIDA PHARMACY #340 Physician Group WAUSHARA FAMILY PHYSICIANS Hospital WILD ROSE COMMUNITY MEM HOSP WILD ROSE COMMUNITY MEMORIAL Independent Lab Physician Group AFFINITY MEDICAL GROUP Physician ALBERT L FISHER, MD Physician ANESTHESIA SERVICES OF THE FOX VALLEY,SC Group Physician Group ASSOCIATION OF HOSPITAL ANESTHESIOLOGISTS Hospital AURORA MEDICAL CTR OF OSHKOS Physician Group AURORA MEDICAL GROU P OSHKOS Pharmacy AURORA PHARMACY INC Hospital CHILDRENS HOSPITAL OF Pharmacy CVS PHARMACY #05186 Physician DAVID J SCHULTZ, MD Physician Group DERMATOLOGY ASSOCIATESOF WI DIGESTIVE HEALTHCARE SPECIALISTS, Physician Group SC Physician DILIP K TANNAN, MD Physician Group EAR NOSE & THROAT SPECIALIST Federally Qualified Health Clinic (FQHC) FOX CITIES COMMUNITY HEALTH CENTER INC Mental Health and Substance Abuse Services Physician Group FOX VALLEY PATHOLOGISTS SC Physician Group FOX VALLEY PLASTIC SURGERY Physician Group FOX VALLEY WOMENS HEALTH SERVICES Page 103 of 114
SFY 2007 $3,343 $558 $4,159 $973 $335 $24,722 $30 $158
SFY 2008 $2,014 $225 $4,652 $949 $157 $97 $21,663
SFY 2009 $645 $183 $3,701 $694 $3,400 $159 $26,545 $66 $182 $6,644 $11,852 $3,145 $400 $367
SFY 2010 $3,829 $1,041 $1,816 $2,760 $6,303 $317 $50,412 $151 $372 $3,087 $17,282 $2,841 $351 $379 $22 $884 $22 $333 $236 $7,387
Total $9,831 $2,007 $14,327 $5,375 $10,194 $573 $123,342 $181 $596 $182 $9,854 $48,964 $9,770 $751 $746 $44 $884 $22 $550 $236 $12,654
$9,911 $2,356
$123 $9,920 $1,428
$22
$217
$1,683
$1,000
$2,584
$2,008
$3,603
$4,954
$22 $7,284 $55 $1,826
$22 $17,849 $55 $1,826
Billing Provider Name Billing Provider Type INTERGRATIVE PAIN MANAGEMENT SCPhysician Group Physician JOHN S PUJALS, MD Pharmacy K MART PHARMACY 4254 Physician KAMALJIT S PAUL, MD Physician KEVIN E WASCO, MD Physician KIRTIDA N RINGWALA, MD Physician Group LAKESIDE NEUROCARE Physician Group MARY MCDONALDMD SC Independent Lab MERCY MEDICAL CENTER OF OSHK MERCY MEDICAL CENTER OF OSHKOSHHospital INC Pharmacy MORTON PHARMACY Physician Group NEUROSCIENCE GROUP OF NE WI Physician NORTHEAST WISCONSIN VISION CENTER, LTD Group Pharmacy OMRO PHARMACY Physician Group ORTHOPAEDIC SPECIALISTS SC Physician PATRICK J BRENNAN, MD Physician PAUL A BOEDER, MD Pharmacy PICK N SAVE PHARMACY #5378 Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician Group RADIOLOGY ASSOCIATES OF THE Physician RAYMOND F GEORGEN, MD Physician ROBERT F MANN, MD Physician ROBERT J HOLLY, MD Physician SHEILA M ANDERSON, MD Pharmacy SHOPKO PHARMACY #2033 Pharmacy SHOPKO PHARMACY #2042 Pharmacy SHOPKO PHARMACY #2100 Ambulatory Surgical Center (ASC) ST ELIZABETHSURGERY CENTER Page 104 of 114
SFY 2007 $37 $1,908
SFY 2008
SFY 2009
SFY 2010 $231
$657 $48 $22 $123 $30 $55 $11,254 $23,814 $5,000 $418 $55 $1,950 $22 $22 $1,917 $763 $73,632 $1,029 $22 $101
$135
$60
$146 $22 $6,679 $10,427 $4,362
$3,097 $1,020 $6,514 $30 $1,265
$3,803 $1,514 $5,511 $73 $1,140
$978
$329
$216 $14,912 $370
$159 $22
$2,516 $6,623 $1,766 $930
$1,848 $7,792 $1,906
$22 $225 $1,039 $7,347 $1,353
$2,592 $5,290 $533 $209
Total $231 $37 $2,565 $48 $22 $464 $52 $55 $24,834 $36,775 $21,387 $521 $55 $5,333 $22 $22 $2,463 $763 $88,544 $1,558 $44 $101 $22 $225 $7,994 $27,052 $5,558 $1,139
Billing Provider Name STUDENT HEALTH CENTER TARGET STORE T-0807 PHARMACY THEDA CARE PHYSICIANS MENASH THEDA CLARK MEDICAL CENTER
Wood
Billing Provider Type Family Planning Clinic Pharmacy Physician Group Hospital Independent Lab P THEDACARE PHYSICIANS NEENAH- EASThysician Group Physician Group THEDACARE PHYSICIANS NEENAH- WEST Physician Group THEDACARE PHYSICIANS OSHKOSH Physician Group THEDACARE PHYSICIANS PEDIATRICS APPLETON Physician THEDACARE PHYSICIANS- PEDIATRICS NEENAH Group Physician Group UROLOGY ASSOC OF WI SC Physician Group VALLEY NEUROLOGY CLINIC SC Pharmacy WALGREENS #03851 Pharmacy WALGREENS #10236 Pharmacy WALGREENS #3392 Pharmacy WALGREENS 04533 Pharmacy WALGREENS 07835 Pharmacy WALGREENS05280 Pharmacy WAL-MART PHARMACY 10-1430 Pharmacy WAL-MART PHARMACY 10-2986 Physician Group WOMENS CARE OF WISCONSIN Physician Group ASPIRUS DOCTORS CLINIC Pharmacy AURORA PHARMACY INC COPPS FOOD CENTER PHARMACY #8121Pharmacy Pharmacy DALY DRUG INC Physician Group DOCTORS CLINIC OF WIS RAPIDS Pharmacy FAMILY HEALTH CENTER OF MARS HOSPITALIST MEDICINE PHYSICIANS OFPhysician Group WISCONSIN RAPID Physician JOEL M CARLSON, MD Page 105 of 114
SFY 2007 $188,521 $277 $1,791 $3,843 $6,741 $451 $750 $575
SFY 2008 $205,246 $946 $992 $2,407 $13,816 $129 $301 $656
SFY 2009 $143,624 $250 $1,710 $26,816 $16,784 $759 $188 $251 $155 $27 $94 $1,626 $1,945 $3,548 $16,358 $3,289 $11,362 $15,639 $3,503 $5,356 $6,910 $688
SFY 2010 $120,453 $2,508 $21,651 $20,550 $3,172
$58 $262 $320 $3,981 $2,355 $9,048 $19,301 $5,223 $17,223 $18,995 $6,354 $8,817 $10,140 $645 $83
$2,635 $1,082 $3,520 $9,625 $3,680 $18,449 $7,596 $2,113 $980 $7,584 $1,019 $197 $1,976 $3,940
$2,874 $2,368 $3,653 $12,476 $3,473 $14,166 $8,984 $2,399 $8,238 $738 $160 $5,138
$867
$758 $143 $61
Total $657,844 $3,981 $4,493 $54,716 $57,892 $4,512 $1,240 $1,483 $58 $155 $289 $414 $11,115 $7,750 $19,769 $57,760 $15,665 $61,200 $51,215 $14,368 $15,153 $32,872 $3,091 $83 $358 $1,976 $10,703 $143 $61
Billing Provider Type Federally Qualified Health Clinic (FQHC) MARSHFIELD CLINIC Physician Group Ambulatory Surgical Center (ASC) MARSHFIELD CLINIC MARSHFIELD Mental Health and Substance Abuse Services MARSHFIELD CLINIC MENTAL Federally Qualified Health Clinic (FQHC) MARSHFIELD CLINIC PHARMACY Independent Lab MARSHFIELD CLINIC WISCONSIN Independent Lab MARSHFIELD LAB OUTREACH TRUS Independent Lab MARSHFIELD MEDICAL CENTER LABORATORY MCDONOUGH ORTHOPAEDIC & SPOR Physician Group Physician Group PARK AND ASSOCIATES SC Pharmacy PHILLIPS NEKOOSA PHARMACY Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Physician Group RIVERVIEW FAMILY CLINIC Independent Lab RIVERVIEW HOSPITAL Physician Group RIVERVIEW HOSPITAL OC RIVERVIEW HOSPITAL ASSOCIATION Hospital Dentist ROBERT A KAY, DDS Pharmacy SHOPKO PHARMACY #2009 Pharmacy SHOPKO PHARMACY #2012 Pharmacy ST JOSEPHS HOSP OUTPATIENT Hospital ST JOSEPHS HOSPITAL Physician Group SURGICAL ASSOCIATES OFWISCO Pharmacy WALGREENS #09009 Pharmacy WALGREENS #13066 Page 106 of 114
SFY 2007 $141,320 $77,173
SFY 2008 $183,545 $108,422 $3,618
SFY 2009 $157,605 $93,117 $724
SFY 2010 $270,552 $128,007
Total $753,021 $406,719 $4,342
$134 $22,040 $118 $8,170 $125 $394 $20,599 $42 $13,177 $256 $55 $433
$48 $25,306 $110 $9,511 $340
$581 $30,615 $357 $18,601 $544
$763 $98,561 $627 $49,459 $1,266 $55 $827 $777 $87,606 $8,151 $15,758 $403 $187,793 $5,645 $35,406 $32,594 $6,798 $19,593 $55 $44,399 $49,184
$2,159 $3,377 $8,415 $1,433 $7,495 $8,080 $339
$1,875 $3,094 $15,750 $2,894 $7,912 $7,944 $1,460 $260 $10,456 $14,208
$20,598 $1,754 $5,280 $81,397 $1,318 $9,107 $7,242 $2,636 $4,351 $55 $12,348 $13,160
$777 $67,009 $2,363 $4,006 $403 $82,230 $10,892 $9,328 $2,363 $14,982 $13,775 $14,188
$7,821 $7,628
Billing Provider Name WAL-MART PHARMACY 10-1202 WISCONSIN RIVER ORTHOPAEDICS
(blank)
Billing Provider Type Pharmacy Physician Group Federally Qualified Health Clinic (FQHC) ACCESS COMMUNITY HEALTH CENTERS Independent Lab ACL SERVICESINC Physician Group ADVANCED HEALTHCARE SC Physician Group ALFREDO C MILLAN MD SC Physician Group ALL SAINTS MEDICAL GROUP Physician ALLAHYAR JAZAYERI, MD Physician Group AMERIPATH MILWAUKEE SC AMERY REGIONAL MEDICALCENTER Physician Group Physician ANNE M DAYER, MD Physician Group ASHLAND PATHOLOGY SERVICES Physician Group ASPIRUS DOCTORS CLINIC Physician Group ASPIRUS GENERAL CLINIC Physician Group ASPIRUS KRONENWETTER CLINIC Physician Group ASPIRUS LAND O LAKES CLINIC Physician Group ASPIRUS OB GYN ASSOCIATES Independent Lab ASSOCIATES IN PATHOLOGYSC Hospital AURORA BAYCARE MEDICALCTR Physician Group AURORA HEALTH CARE INC Physician Group AURORA HEALTH CARE METRO INC Physician Group AURORA HEALTH CENTER AURORA HEALTH CENTER HARTFOR Physician Group AURORA HEALTH CENTER KENOSHA Physician Group Physician Group AURORA HEALTH CENTER RACINE Rural Health Clinic AURORA HEALTHCENTER Physician Group AURORA MEDICAL GROU P OSHKOS Physician Group AURORA MEDICAL GROUP Page 107 of 114
SFY 2007 $2,682
SFY 2008 $3,952
SFY 2009 $5,817
SFY 2010 $8,702 $233
Total $21,152 $233 $99 $218 $172 $30 $521 $57 $936 $467 $22 $39 $188 $125 $114 $30 $486 $655 $6,360 $83 $72 $481 $22 $2,122 $385 $165 $87 $4,360
$99 $218 $172 $30 $521 $57 $936 $467 $22 $39 $188 $125 $114 $30 $486 $655 $6,360 $83 $72 $481 $22 $2,122 $385 $165 $87 $4,360
Billing Provider Name Billing Provider Type Physician Group AURORA MEDICAL GROUP INC AURORA MEDICAL GROUP MILWAUKEEPhysician Group AURORA MEDICAL GROUP WEST BEND Physician Group Rural Health Clinic AURORA NOR DOOR CLINIC Physician Group AURORA VALLEY VIEW CAMPUS OF AURORA WILKINSON MEDICAL CLINIC Physician Group Physician Group AURORA WISELIVES CLINIC Rural Health Clinic BALDWIN CLINIC Federally Qualified Health BELOIT AREA COMMUNITY HEALTH CENTER Clinic (FQHC) Physician Group BELOIT CLINIC Independent Lab BOARD OF REGENTS UNIV OF WI Physician Group BUTTE DES MORTS PATHOLOGY SC Physician Group CHEQUAMEGON CLINIC Physician Group CHN MEDICAL CENTER BERLIN CHN MEDICAL CENTER GREEN LAKE Physician Group CHN MEDICAL CENTER REDGRANITE Physician Group Physician Group CHN MEDICAL CTR EASTRIDGE Physician Group CHN OB/GYN Family Planning Clinic CLARK CO FAMILY PLANNING Physician CLARK W STEVENS MD, MD Pharmacy CLINIC PHARMACY OF WEST SALEM INC Hospital COLUMBIA CENTER INC Independent Lab CONSULTANTS LABORATORYOF Family Planning Clinic COUNTY OF BURNETT Physician Group CSM HOSPITAL MILWAUKEE Independent Lab DANE CO CYTOLOGY CENTERINC Physician Group DC WEST Physician Group DEAN HEALTH SYSTEMS INC Page 108 of 114
SFY 2007 $87 $77 $44 $108 $22 $296 $114 $131 $30 $120 $1,484 $610 $30 $57 $24 $60 $11 $147 $1,624 $177 $54 $4,518 $153 $49 $22 $578 $30 $852
SFY 2008
SFY 2009
SFY 2010
Total $87 $77 $44 $108 $22 $296 $114 $131 $30 $120 $1,484 $610 $30 $57 $24 $60 $11 $147 $1,624 $177 $54 $4,518 $153 $49 $22 $578 $30 $852
Billing Provider Name Billing Provider Type Physician Group DIAGNOSTIC RADIOLOGY ASSOC Physician DIAGNOSTIC SERVICES OFWASHINGTON CTY Group Physician Group DOCTORS CLINIC OF WIS RAPIDS Hospital DOOR CO MEMORIAL HOSPITAL Family Planning Clinic DOUGLAS CO COMMUNITY HLTH Physician Group DULUTH CLINIC LTD Family Planning Clinic DUNN COUNTY PUBLIC HLTH Hospital ESSENTIA HEALTH DULUTH ESSENTIA HEALTH HAYWARD CLINIC Physician Group Physician Group FAMILY HEALTH OF LAFAYETTE COUNTY Physician Group FAMILY HEALTHSERVICES SC Family Planning Clinic FAMILY PLANNING HEALTHSERVI F FIRST CHOICEWOMENS HEALTH CENTERamily Planning Clinic Physician Group FOND DU LAC PATHOLOGY CONSUL Physician Group FOND DU LAC REGIONAL CLINIC Physician GARY R SCHERR, MD Physician GEORGE A NORRIS, MD Physician Group GRAND VIEW CLINIC Hospital GRAND VIEW HOSPITAL Physician Group GREAT LAKES Physician Group GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI Physician Group GUNDERSEN CLINIC LTD Physician Group HAYWARD AREAMEMORIAL HOSP Physician Group HEART CARE ASSOC Physician Group HESS MEMORIAL HOSPITALINC Physician Group HFM WOMENS HEALTH Rural Health Clinic HIRSCH CLINICVMH Federally Qualified Health Clinic (FQHC) HOCHUNK NATION WELLNESS Page 109 of 114
SFY 2007 $110 $239 $499 $30 $882 $436 $125 $1,408 $47 $77 $566 $6,822 $7,757 $501 $99 $39 $79 $57 $44 $867 $207 $898 $190 $60 $32 $22 $308 $19
SFY 2008
SFY 2009
SFY 2010
Total $110 $239 $499 $30 $882 $436 $125 $1,408 $47 $77 $566 $6,822 $7,757 $501 $99 $39 $79 $57 $44 $867 $207 $898 $190 $60 $32 $22 $308 $19
Billing Provider Name HOLY FAMILY MEMORIAL INC HOSPITAL PATHOLOGY ASSOC PA HUDSON PHYSICIANS IRON COUNTY HEALTH DEPARTMENT JEFFREY J ANDEREGG, MD KAREN B HIMMEL, MD KETTLE MORAINE ANESTHESIOLOG LABORATORY CORPORATIONOF LABORATORY CORPORATIONOF AM LABWORKS INC LAKESHORE MEDICAL CLINIC LCM PATHOLOGISTS PC MARINER MEDICAL CLINIC
Billing Provider Type Physician Group Physician Group Physician Group Family Planning Clinic Physician Physician Physician Group Independent Lab Independent Lab Physician Group Physician Group Independent Lab Physician Group Federally Qualified Health Clinic (FQHC) MARSHFIELD CLINIC Independent Lab Physician Group Independent Lab MARSHFIELD CLINIC EAU Independent Lab MARSHFIELD CLINIC MENOMONIE Independent Lab MARSHFIELD CLINIC MERCER MARSHFIELD CLINIC MERRILL CENTER Independent Lab LAB Independent Lab MARSHFIELD CLINIC MINOCQUA C Physician Group Independent Lab MARSHFIELD CLINIC OAKWOOD Independent Lab MARSHFIELD CLINIC RICE LAKE CENTER Independent Lab MARSHFIELD CLINIC RIVERVIEW CENTER LAB Independent Lab MARSHFIELD CLINIC WAUSAU Ambulatory Surgical Center (ASC) MARSHFIELD CLINIC WAUSAU AMB Page 110 of 114
SFY 2007 $261 $44 $512 $138 $84 $27 $222 $346 $845 $101 $208 $347 $71 $44,481 $10 $23,561 $281 $31 $21 $21 $227 $509 $21 $174 $42 $268 $724
SFY 2008
SFY 2009
SFY 2010
Total $261 $44 $512 $138 $84 $27 $222 $346 $845 $101 $208 $347 $71 $44,481 $10 $23,561 $281 $31 $21 $21 $227 $509 $21 $174 $42 $268 $724
Billing Provider Name Billing Provider Type SFY 2007 Independent Lab MARSHFIELD CLINIC WISCONSIN $21 Independent Lab MARSHFIELD LAB OUTREACH TRUS $1,359 Independent Lab MARSHFIELD MEDICAL CENTER LABORATORY $71 Physician Group MARSHO FAMILY MEDICAL GROUP $90 Physician Group MAYO CLINIC HEALTH SYSTEM EAU CLAIRE CLINIC INC $413 Physician Group MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTE $1,550 Independent Lab MAYO MEDICALLABORATORIES $50 Physician Group MEDPOINT FAMILY CARE CENTER $82 Physician Group MEMORIAL HEALTH CENTERCLINI $57 Hospital MEMORIAL MEDICAL CENTER INC $23 Rural Health Clinic MEMORIAL MEDICAL CTR $119 Physician Group MHS PHYSICIAN SERVICES $678 Federally Qualified Health Clinic (FQHC) MILWAUKEE HEALTH SERVICES $52 Physician Group MINISTRY MEDICAL GROUP $69 Physician NARAYAN BALIGA, MD $193 Independent Lab NATIONAL HEALTH LABORATORY $414 Physician Group NEW RICHMONDCLINIC $51 Family Planning Clinic NEWCAP WHS $535 Physician Group NORTH SHORE PATHOLOGISTS $152 Federally Qualified NORTH WOODS COMMUNITY HEALTH Health Clinic (FQHC) $75 Physician Group NORTHREACH HEALTHCARE LLC $90 Physician Group NORTHWOODS ANESTHESIA SERVICES SC $77 Hospital OAKLEAF SURGICAL HOSPITAL $35,034 Federally Qualified Health Clinic (FQHC) ONEIDA COMMUNITY HEALTH $186 ONEIDA COUNTYHEALTH DEPARTME Family Planning Clinic $57 Family Planning Clinic OPTIONS IN REPRODUCTIVECARE $16,397 Page 111 of 114
SFY 2008
SFY 2009
SFY 2010
Total $21 $1,359 $71 $90 $413 $1,550 $50 $82 $57 $23 $119 $678 $52 $69 $193 $414 $51 $535 $152 $75 $90 $77 $35,034 $186 $57 $16,397
Billing Provider Name Billing Provider Type PATHOLOGY CONSULTANTS OF GREEN Physician Group BAY, SC Physician Group PATHOLOGY PHYSICIANS LTD Physician PETER S KAROFSKY, MD Family Planning Clinic PIERCE CO REPRODUCTIVE HEALTH Family PLANNED PARENTHHOOD OF WISCONSIN, INC.Planning Clinic Family Planning Clinic PLANNED PARENTHOOD Family Planning Clinic PLANNED PARENTHOOD OF WI Family Planning Clinic PLANNED PARENTHOOD OF WISC Family PLANNED PARENTHOOD OF WISCONSIN, INC Planning Clinic Family PLANNED PARENTHOOD OF WISCONSIN, INC. Planning Clinic Family Planning Clinic POLK CO HEALTH DEPARTMENT Independent Lab PREVEA CLINIC Physician Group Family Planning Clinic PRICE COUNTYHEALTH Physician Group PROCARE MEDICAL GROUP Federally Qualified Health Clinic (FQHC) PROGRESSIVE COMMUNITY HEALTH CENTERS Independent Lab QUEST DIAGNOSTICS LLC IL SACRED HEART ST MARYS HOSPITAL Physician Group Physician Group SHAFI MEDICAL CENTER SC Physician Group SHEBOYGAN WOMENS HEALTH SC Pharmacy SHOPKO PHARMACY #2018 SOUTHEASTERN WI ANESTHESIOLOGY Physician Group Family Planning Clinic SOUTHWEST COMMUNITY ACTION Ambulatory Surgical Center (ASC) ST ELIZABETHSURGERY CENTER Physician Group ST JOSEPHS HEALTH SERVICES INC Hospital ST LUKES HOSPITAL Physician Group ST LUKES URGENT CARE Page 112 of 114
SFY 2007 $968 $22 $88 $1,173 $2,160 $8,424 $1,806 $17,280 $7,935 $20,847 $43 $650 $104 $6,957 $36 $73 $1,713 $522 $108 $130 $30 $105 $3,002 $2,895 $57 $4,850 $22
SFY 2008
SFY 2009
SFY 2010
Total $968 $22 $88 $1,173 $2,160 $8,424 $1,806 $17,280 $7,935 $20,847 $43 $650 $104 $6,957 $36 $73 $1,713 $522 $108 $130 $30 $105 $3,002 $2,895 $57 $4,850 $22
Billing Provider Name ST MARYS DEAN VENTURES INC ST MARYS DEAN VENTURESINC ST MICHAELS HOSPITAL
Billing Provider Type Physician Group Rural Health Clinic Hospital Physician Group Physician ST MICHAELS HOSPITAL OF STEVENS POINT INC Group Physician STEVEN D STENZEL, MD Family Planning Clinic STUDENT HEALTH CENTER Ambulatory Surgical Center (ASC) SURGERY & CARE CENTER ST MAR Pharmacy THE APOTHECARY Independent Lab THE DIAGNOSTIC & TREATMENT THE MEDICAL COLLEGE OF WISCONSIN Physician Group INC Family Planning Clinic THE MEDICAL COLLEGE OFWI IN Family Planning Clinic THE MEDICAL COLLEGE OFWISCO Physician Group THREE RIVERSPATHOLOGYPA Family Planning Clinic U OF WISCONSIN EAU CLAIRE Physician Group UHS PHYSICIAN CLINIC Independent Lab UNITED DYNACARE LLC Pharmacy UNIVERSITY HEALTH SERVICE PH Physician Group UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION UW HEALTH OUTPATIENT PHARMAC Pharmacy Physician Group UW MEDICAL FOUNDATION INC Physician Group UW MEDICAL FOUNDTION EAU CLA Physician Group VALLEY ORTHOPEDIC CLINIC SC Family Planning Clinic VILAS COUNTYHEALTH Physician Group VINCENT G LUBSEY MD SC Pharmacy WALGREENS #02927 Pharmacy WALGREENS #03115 Pharmacy WALGREENS #10555 Page 113 of 114
SFY 2007 $164 $22 $257 $1,915 $107 $57 $232 $724 $37 $320 $3,546 $175 $112 $2,432 $928 $30 $85 $98 $408 $381 $57 $100 $22 $127 $47 $43 $223 $28
SFY 2008
SFY 2009
SFY 2010
Total $164 $22 $257 $1,915 $107 $57 $232 $724 $37 $320 $3,546 $175 $112 $2,432 $928 $30 $85 $98 $408 $381 $57 $100 $22 $127 $47 $43 $223 $28
Grand Total
Billing Provider Name Billing Provider Type SFY 2007 Pharmacy WALGREENS #12693 $34 Pharmacy WALGREENS 05636 $30 Pharmacy WALGREENS 07635 $141 Pharmacy WALGREENS 09168 $72 Pharmacy WAL-MART PHARMACY 10-1643 $39 Pharmacy WAL-MART PHARMACY 10-1669 $154 Pharmacy WAL-MART PHARMACY 10-2421 $83 Pharmacy WAL-MART PHARMACY 10-2510 $31 Pharmacy WAL-MART PHARMACY 10-5090 $44 Pharmacy WAL-MART PHARMACY 10-5373 $39 Family Planning Clinic WASHBURN COUNTY HEALTHDEPT $1,786 Physician Group WATERTOWN FAMILY PRACTICE $12 WELLNESS CENTER OF DOOR COUNTY Family Planning Clinic $352 Physician Group WEST BEND CLINIC INC $51 Family Planning Clinic WESTERN DAIRYLAND ECONOMIC OPPORTUNITY COUNCIL INC $10,497 WHEATON FRANCISCAN LABORATOR Independent Lab $142 WOMENS HEALTH & RESOURCE CEN Family Planning Clinic $431 Physician YOON W CHUN MD, MD $155 $15,822,365
SFY 2008
SFY 2009
SFY 2010
Total $34 $30 $141 $72 $39 $154 $83 $31 $44 $39 $1,786 $12 $352 $51 $10,497 $142 $431 $155 $81,583,185
$16,707,743
$20,248,201
$28,804,876
Page 114 of 114

Wisconsin - Claims Paid - FPW - 2007-2010

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Wisconsin - Claims Paid - FPW - 2007-2010

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Medicaid Expenditures for the Family Planning Only Benefit Plan Claims Paid in SFY 2007 through SFY

Billing Provider County

Billing Provider Name

$1,540 $2,220 $3,197 $1,481

$1,199 $5,823 $3,868 $1,464

$68 $138 $3,582 $27,433 $572 $1,316 $1,656

$2,442 $709 $125 $105 $3,735 $12

$2,270 $472 $137 $217 $2,201 $58,830

$94 $3,427 $246,566 $3,814 $44 $4,676 $30

$41 $1,534 $1,897 $1,895 $108 $3,934

Billing Provider County

Billing Provider Name MARJORIE A LINDEMANN, NP MEMORIAL MEDICAL CENTER

SFY 2008 $582 $726 $2,131 $7,065 $4,183 $109,880 $2,106

$991 $690 $3,550 $3,256 $129 $532

$35 $1,783 $392 $2,513 $943 $1,969

$10 $2,839 $831

$21 $2,630 $675

Billing Provider County

SFY 2008 $1,418 $869 $4,755 $643 $1,180 $7,582 $2,622

$16,396 $643 $1,914 $34 $72

$3,699 $16,805 $2,505 $2,353

$1,362 $1,717 $9,996 $1,417 $733 $2,463 $338 $7,506

Billing Provider County

SFY 2007 $59 $20 $1,020 $343 $362 $30 $2,719

SFY 2008 $22 $1,368 $494 $60 $1,698 $57

SFY 2009 $216 $1,270 $10,303

SFY 2010 $58 $145 $1,266 $19,788 $55

$1,002 $58 $34 $87 $301 $256 $2,682 $3,473 $2,289

$1,229 $959 $1,903 $2,476 $1,156 $60

$1,131 $1,213 $4,030 $3,399 $3,280

$681 $2,061 $3,454 $1,556 $160 $92

$139 $164 $60 $766 $60 $395 $90

$299 $55 $231

$1,536 $47 $349 $36 $87

$1,136 $384 $581 $30 $76

$2,459 $204 $2,658 $993 $229 $251

Billing Provider County

SFY 2007 $174 $66 $86 $1,608

SFY 2008 $250 $26 $73 $216 $1,176 $57 $98

SFY 2009 $271 $57 $230 $926 $30

$133 $163 $141

$26 $55 $354

Billing Provider County

SFY 2007 $735 $19

SFY 2008 $236

SFY 2009 $22 $1,034 $22 $30

$111 $199 $266 $385 $174

$66 $9,702 $125

$4,074 $245 $80 $156,989 $3,737 $9,792

$44,685 $3,985 $13,757

$58 $179,784 $3,850 $6,931

$225,793 $2,261 $5,738

$43 $3,350 $11,036

$2,833 $3,350 $11,036 $11

Billing Provider County

SFY 2008 $935

SFY 2010 $132 $338 $227

Billing Provider County

SFY 2007 $6,678

Billing Provider County

Billing Provider Name AURORA PHARMACY INC CALUMET MEDICAL CENTER

SFY 2007 $221

SFY 2008 $196