| National Provider Identifier [NPI]: | 1689621856 |
| Last Name Of The Provider | JOSE |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4801 W 81ST ST |
| Street Address 2 Of The Provider | SUITE 108 |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 554371111 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 2835 |
| Number Of Medicare Beneficiaries | 1509 |
| Total Submitted Charge Amount | 369195.42 |
| Total Medicare Allowed Amount | 117043.68 |
| Total Medicare Payment Amount | 92368.13 |
| Total Medicare Standardized Payment Amount | 95273.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 342 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 388.92 |
| Total Drug Medicare AllowedAmount | 313.59 |
| Total Drug Medicare PaymentAmount | 245.84 |
| Total Drug Medicare Standardized Payment Amount | 245.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 2493 |
| Number Of Medicare Beneficiaries With Medical Services | 1509 |
| Total Medical Submitted Charge Amount | 368806.5 |
| Total Medical Medicare Allowed Amount | 116730.09 |
| Total Medical Medicare Payment Amount | 92122.29 |
| Total Medical Medicare Standardized Payment Amount | 95027.62 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 457 |
| Number Of Beneficiaries Age 65 to 74 | 429 |
| Number Of Beneficiaries Age 75 to 84 | 381 |
| Number Of Beneficiaries Age Greater 84 | 242 |
| Number Of Female Beneficiaries | 1005 |
| Number Of Male Beneficiaries | 504 |
| Number Of Non Hispanic White Beneficiaries | 1390 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1009 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 500 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5354 |