| National Provider Identifier [NPI]: | 1154300929 |
| Last Name Of The Provider | WITTENBERG |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 166 4TH ST E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551011421 |
| 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 | 162 |
| Number Of Services | 3914 |
| Number Of Medicare Beneficiaries | 2115 |
| Total Submitted Charge Amount | 380585.18 |
| Total Medicare Allowed Amount | 113057.43 |
| Total Medicare Payment Amount | 84662.7 |
| Total Medicare Standardized Payment Amount | 87770.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 951 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 3950.5 |
| Total Drug Medicare AllowedAmount | 349.13 |
| Total Drug Medicare PaymentAmount | 273.7 |
| Total Drug Medicare Standardized Payment Amount | 273.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 156 |
| Number Of Medical Services | 2963 |
| Number Of Medicare Beneficiaries With Medical Services | 2113 |
| Total Medical Submitted Charge Amount | 376634.68 |
| Total Medical Medicare Allowed Amount | 112708.3 |
| Total Medical Medicare Payment Amount | 84389 |
| Total Medical Medicare Standardized Payment Amount | 87496.38 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 668 |
| Number Of Beneficiaries Age 65 to 74 | 606 |
| Number Of Beneficiaries Age 75 to 84 | 508 |
| Number Of Beneficiaries Age Greater 84 | 333 |
| Number Of Female Beneficiaries | 1192 |
| Number Of Male Beneficiaries | 923 |
| Number Of Non Hispanic White Beneficiaries | 1780 |
| Number Of Black or African American Beneficiaries | 176 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | 24 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1382 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 733 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7016 |