| National Provider Identifier [NPI]: | 1699764456 |
| Last Name Of The Provider | MITTRA |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7760 FRANCE AVE S |
| Street Address 2 Of The Provider | SUITE 310 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554355800 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 13004 |
| Number Of Medicare Beneficiaries | 998 |
| Total Submitted Charge Amount | 3163365.25 |
| Total Medicare Allowed Amount | 2848254.58 |
| Total Medicare Payment Amount | 2199000.61 |
| Total Medicare Standardized Payment Amount | 2207239.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 5080 |
| Number Of Medicare Beneficiaries With Drug Services | 448 |
| Total Drug Submitted ChargeAmount | 2244109.16 |
| Total Drug Medicare AllowedAmount | 1971991.1 |
| Total Drug Medicare PaymentAmount | 1540974.11 |
| Total Drug Medicare Standardized Payment Amount | 1540974.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 7924 |
| Number Of Medicare Beneficiaries With Medical Services | 998 |
| Total Medical Submitted Charge Amount | 919256.09 |
| Total Medical Medicare Allowed Amount | 876263.48 |
| Total Medical Medicare Payment Amount | 658026.5 |
| Total Medical Medicare Standardized Payment Amount | 666264.92 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 258 |
| Number Of Beneficiaries Age 75 to 84 | 329 |
| Number Of Beneficiaries Age Greater 84 | 315 |
| Number Of Female Beneficiaries | 575 |
| Number Of Male Beneficiaries | 423 |
| Number Of Non Hispanic White Beneficiaries | 949 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 879 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3685 |