| National Provider Identifier [NPI]: | 1295785574 |
| Last Name Of The Provider | RICE |
| First Name Of The Provider | SAM |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 328 W CONAN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELY |
| Zip Code Of The Provider | 557311145 |
| 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 | 22 |
| Number Of Services | 579 |
| Number Of Medicare Beneficiaries | 499 |
| Total Submitted Charge Amount | 251365 |
| Total Medicare Allowed Amount | 67418.76 |
| Total Medicare Payment Amount | 50958.35 |
| Total Medicare Standardized Payment Amount | 53841.95 |
| 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 | 22 |
| Number Of Medical Services | 579 |
| Number Of Medicare Beneficiaries With Medical Services | 499 |
| Total Medical Submitted Charge Amount | 251365 |
| Total Medical Medicare Allowed Amount | 67418.76 |
| Total Medical Medicare Payment Amount | 50958.35 |
| Total Medical Medicare Standardized Payment Amount | 53841.95 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 190 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 104 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 269 |
| Number Of Male Beneficiaries | 230 |
| Number Of Non Hispanic White Beneficiaries | 405 |
| Number Of Black or African American Beneficiaries | 63 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 292 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 207 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8927 |