| National Provider Identifier [NPI]: | 1689651093 |
| Last Name Of The Provider | SPONG |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 516 DELWARE ST SE PWB CLINIC 2A |
| Street Address 2 Of The Provider | UNIVERSITY OF MINNESOTA PHYSICIANS |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554550356 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 859 |
| Number Of Medicare Beneficiaries | 364 |
| Total Submitted Charge Amount | 271061 |
| Total Medicare Allowed Amount | 95809.55 |
| Total Medicare Payment Amount | 71300.5 |
| Total Medicare Standardized Payment Amount | 75007.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 859 |
| Number Of Medicare Beneficiaries With Medical Services | 364 |
| Total Medical Submitted Charge Amount | 271061 |
| Total Medical Medicare Allowed Amount | 95809.55 |
| Total Medical Medicare Payment Amount | 71300.5 |
| Total Medical Medicare Standardized Payment Amount | 75007.26 |
| Average Age Of Beneficiaries | 55 |
| Number Of Beneficiaries Age Less65 | 258 |
| Number Of Beneficiaries Age 65 to 74 | 80 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 149 |
| Number Of Male Beneficiaries | 215 |
| Number Of Non Hispanic White Beneficiaries | 266 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 209 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 155 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 16 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 4.3692 |