| National Provider Identifier [NPI]: | 1255431524 |
| Last Name Of The Provider | HOLSINGER |
| First Name Of The Provider | JILL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 EAST 3RD STREET |
| Street Address 2 Of The Provider | SMDC MEDICAL CENTER-DULUTH CLINIC |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 55805 |
| 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 | 191 |
| Number Of Services | 4714 |
| Number Of Medicare Beneficiaries | 2677 |
| Total Submitted Charge Amount | 520093 |
| Total Medicare Allowed Amount | 116060.86 |
| Total Medicare Payment Amount | 90167.04 |
| Total Medicare Standardized Payment Amount | 93178.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 269 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 3886 |
| Total Drug Medicare AllowedAmount | 656.51 |
| Total Drug Medicare PaymentAmount | 459.06 |
| Total Drug Medicare Standardized Payment Amount | 459.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 4445 |
| Number Of Medicare Beneficiaries With Medical Services | 2674 |
| Total Medical Submitted Charge Amount | 516207 |
| Total Medical Medicare Allowed Amount | 115404.35 |
| Total Medical Medicare Payment Amount | 89707.98 |
| Total Medical Medicare Standardized Payment Amount | 92719.47 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 748 |
| Number Of Beneficiaries Age 65 to 74 | 986 |
| Number Of Beneficiaries Age 75 to 84 | 621 |
| Number Of Beneficiaries Age Greater 84 | 322 |
| Number Of Female Beneficiaries | 1734 |
| Number Of Male Beneficiaries | 943 |
| Number Of Non Hispanic White Beneficiaries | 2488 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 109 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1803 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 874 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4167 |