| National Provider Identifier [NPI]: | 1053413708 |
| Last Name Of The Provider | LIEBERMAN |
| First Name Of The Provider | KRISTIN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| 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 | 102 |
| Number Of Services | 6022 |
| Number Of Medicare Beneficiaries | 1593 |
| Total Submitted Charge Amount | 2070107.83 |
| Total Medicare Allowed Amount | 173568.53 |
| Total Medicare Payment Amount | 129595.19 |
| Total Medicare Standardized Payment Amount | 138251.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 3911 |
| Number Of Medicare Beneficiaries With Drug Services | 140 |
| Total Drug Submitted ChargeAmount | 15516.2 |
| Total Drug Medicare AllowedAmount | 3763.63 |
| Total Drug Medicare PaymentAmount | 2873.17 |
| Total Drug Medicare Standardized Payment Amount | 2873.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 2111 |
| Number Of Medicare Beneficiaries With Medical Services | 1593 |
| Total Medical Submitted Charge Amount | 2054591.63 |
| Total Medical Medicare Allowed Amount | 169804.9 |
| Total Medical Medicare Payment Amount | 126722.02 |
| Total Medical Medicare Standardized Payment Amount | 135378.62 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 401 |
| Number Of Beneficiaries Age 65 to 74 | 558 |
| Number Of Beneficiaries Age 75 to 84 | 440 |
| Number Of Beneficiaries Age Greater 84 | 194 |
| Number Of Female Beneficiaries | 904 |
| Number Of Male Beneficiaries | 689 |
| Number Of Non Hispanic White Beneficiaries | 1536 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1073 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 520 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4164 |