| National Provider Identifier [NPI]: | 1346206208 |
| Last Name Of The Provider | BURGESON |
| First Name Of The Provider | STEPHAN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1875 WOODWINDS DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBURY |
| Zip Code Of The Provider | 551252298 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 1722 |
| Number Of Medicare Beneficiaries | 241 |
| Total Submitted Charge Amount | 132654.07 |
| Total Medicare Allowed Amount | 63958.58 |
| Total Medicare Payment Amount | 48361.96 |
| Total Medicare Standardized Payment Amount | 49543.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 219 |
| Number Of Medicare Beneficiaries With Drug Services | 97 |
| Total Drug Submitted ChargeAmount | 12133.18 |
| Total Drug Medicare AllowedAmount | 9721.54 |
| Total Drug Medicare PaymentAmount | 9166.19 |
| Total Drug Medicare Standardized Payment Amount | 9166.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 1503 |
| Number Of Medicare Beneficiaries With Medical Services | 241 |
| Total Medical Submitted Charge Amount | 120520.89 |
| Total Medical Medicare Allowed Amount | 54237.04 |
| Total Medical Medicare Payment Amount | 39195.77 |
| Total Medical Medicare Standardized Payment Amount | 40376.85 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 89 |
| Number Of Beneficiaries Age 75 to 84 | 85 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 115 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 224 |
| Number Of Black or African American Beneficiaries | |
| 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 | 215 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1514 |