| National Provider Identifier [NPI]: | 1326005976 |
| Last Name Of The Provider | DESHAW |
| First Name Of The Provider | LAWRENCE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 E NICOLLET BLVD |
| Street Address 2 Of The Provider | FAIRVIEW RIDGES HOSPITAL |
| City Of The Provider | BURNSVILLE |
| Zip Code Of The Provider | 55337 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 500 |
| Number Of Medicare Beneficiaries | 246 |
| Total Submitted Charge Amount | 49918.5 |
| Total Medicare Allowed Amount | 21285.51 |
| Total Medicare Payment Amount | 14959.75 |
| Total Medicare Standardized Payment Amount | 15196.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 95 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 326 |
| Total Drug Medicare AllowedAmount | 133.85 |
| Total Drug Medicare PaymentAmount | 97.42 |
| Total Drug Medicare Standardized Payment Amount | 97.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 405 |
| Number Of Medicare Beneficiaries With Medical Services | 246 |
| Total Medical Submitted Charge Amount | 49592.5 |
| Total Medical Medicare Allowed Amount | 21151.66 |
| Total Medical Medicare Payment Amount | 14862.33 |
| Total Medical Medicare Standardized Payment Amount | 15099.09 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 74 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 98 |
| Number Of Non Hispanic White Beneficiaries | 220 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 165 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 81 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1968 |