| National Provider Identifier [NPI]: | 1164498820 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | BRYAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11475 ROBINSON DRIVE NW-MAILSTOP 32600A |
| Street Address 2 Of The Provider | HEALTHPARTNERS COON RAPIDS CLINIC |
| City Of The Provider | COON RAPIDS |
| Zip Code Of The Provider | 554333746 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 462 |
| Number Of Medicare Beneficiaries | 56 |
| Total Submitted Charge Amount | 42453.95 |
| Total Medicare Allowed Amount | 17459.5 |
| Total Medicare Payment Amount | 13465.99 |
| Total Medicare Standardized Payment Amount | 13760.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 94 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 1415.95 |
| Total Drug Medicare AllowedAmount | 266.83 |
| Total Drug Medicare PaymentAmount | 229.33 |
| Total Drug Medicare Standardized Payment Amount | 229.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 368 |
| Number Of Medicare Beneficiaries With Medical Services | 55 |
| Total Medical Submitted Charge Amount | 41038 |
| Total Medical Medicare Allowed Amount | 17192.67 |
| Total Medical Medicare Payment Amount | 13236.66 |
| Total Medical Medicare Standardized Payment Amount | 13530.88 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 35 |
| Number Of Male Beneficiaries | 21 |
| Number Of Non Hispanic White Beneficiaries | 33 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 19 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3046 |