| National Provider Identifier [NPI]: | 1750478319 |
| Last Name Of The Provider | FUGLESTAD |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8559 EDINBROOK PKWY |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | BROOKLYN PARK |
| Zip Code Of The Provider | 554433747 |
| 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 | 54 |
| Number Of Services | 1626 |
| Number Of Medicare Beneficiaries | 209 |
| Total Submitted Charge Amount | 132203 |
| Total Medicare Allowed Amount | 52719.36 |
| Total Medicare Payment Amount | 38360.43 |
| Total Medicare Standardized Payment Amount | 38955.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 179 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 6730 |
| Total Drug Medicare AllowedAmount | 5235.7 |
| Total Drug Medicare PaymentAmount | 4945 |
| Total Drug Medicare Standardized Payment Amount | 4945 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 1447 |
| Number Of Medicare Beneficiaries With Medical Services | 208 |
| Total Medical Submitted Charge Amount | 125473 |
| Total Medical Medicare Allowed Amount | 47483.66 |
| Total Medical Medicare Payment Amount | 33415.43 |
| Total Medical Medicare Standardized Payment Amount | 34010.88 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 185 |
| 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 | 169 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.992 |