| National Provider Identifier [NPI]: | 1861471633 |
| Last Name Of The Provider | WOLD |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | B |
| 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 | 174 |
| Number Of Services | 13646 |
| Number Of Medicare Beneficiaries | 3217 |
| Total Submitted Charge Amount | 668947.86 |
| Total Medicare Allowed Amount | 231904.82 |
| Total Medicare Payment Amount | 187468.86 |
| Total Medicare Standardized Payment Amount | 192797.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 8809 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 18362.5 |
| Total Drug Medicare AllowedAmount | 3480.79 |
| Total Drug Medicare PaymentAmount | 2728.95 |
| Total Drug Medicare Standardized Payment Amount | 2728.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 167 |
| Number Of Medical Services | 4837 |
| Number Of Medicare Beneficiaries With Medical Services | 3217 |
| Total Medical Submitted Charge Amount | 650585.36 |
| Total Medical Medicare Allowed Amount | 228424.03 |
| Total Medical Medicare Payment Amount | 184739.91 |
| Total Medical Medicare Standardized Payment Amount | 190068.87 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 684 |
| Number Of Beneficiaries Age 65 to 74 | 1090 |
| Number Of Beneficiaries Age 75 to 84 | 852 |
| Number Of Beneficiaries Age Greater 84 | 591 |
| Number Of Female Beneficiaries | 2110 |
| Number Of Male Beneficiaries | 1107 |
| Number Of Non Hispanic White Beneficiaries | 2881 |
| Number Of Black or African American Beneficiaries | 149 |
| Number Of AsianPacific Islander Beneficiaries | 65 |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2408 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 809 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5658 |