| National Provider Identifier [NPI]: | 1003862996 |
| Last Name Of The Provider | FRY |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1221 NICOLLET AVE |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554032420 |
| 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 | 55 |
| Number Of Services | 2181 |
| Number Of Medicare Beneficiaries | 1093 |
| Total Submitted Charge Amount | 587058.08 |
| Total Medicare Allowed Amount | 159617.61 |
| Total Medicare Payment Amount | 120835.45 |
| Total Medicare Standardized Payment Amount | 124961.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 696 |
| Number Of Medicare Beneficiaries With Drug Services | 58 |
| Total Drug Submitted ChargeAmount | 2644.7 |
| Total Drug Medicare AllowedAmount | 1850.21 |
| Total Drug Medicare PaymentAmount | 1436.2 |
| Total Drug Medicare Standardized Payment Amount | 1436.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1485 |
| Number Of Medicare Beneficiaries With Medical Services | 1093 |
| Total Medical Submitted Charge Amount | 584413.38 |
| Total Medical Medicare Allowed Amount | 157767.4 |
| Total Medical Medicare Payment Amount | 119399.25 |
| Total Medical Medicare Standardized Payment Amount | 123525.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 279 |
| Number Of Beneficiaries Age 65 to 74 | 313 |
| Number Of Beneficiaries Age 75 to 84 | 347 |
| Number Of Beneficiaries Age Greater 84 | 154 |
| Number Of Female Beneficiaries | 629 |
| Number Of Male Beneficiaries | 464 |
| Number Of Non Hispanic White Beneficiaries | 1017 |
| Number Of Black or African American Beneficiaries | 36 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 810 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 283 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.228 |