| National Provider Identifier [NPI]: | 1447280698 |
| Last Name Of The Provider | OLDS |
| First Name Of The Provider | TED |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2019 S 6TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BRAINERD |
| Zip Code Of The Provider | 564014528 |
| 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 | 165 |
| Number Of Services | 3060 |
| Number Of Medicare Beneficiaries | 1820 |
| Total Submitted Charge Amount | 341393.41 |
| Total Medicare Allowed Amount | 93632.17 |
| Total Medicare Payment Amount | 72072.61 |
| Total Medicare Standardized Payment Amount | 74437.42 |
| 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 | 165 |
| Number Of Medical Services | 3060 |
| Number Of Medicare Beneficiaries With Medical Services | 1820 |
| Total Medical Submitted Charge Amount | 341393.41 |
| Total Medical Medicare Allowed Amount | 93632.17 |
| Total Medical Medicare Payment Amount | 72072.61 |
| Total Medical Medicare Standardized Payment Amount | 74437.42 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 466 |
| Number Of Beneficiaries Age 65 to 74 | 519 |
| Number Of Beneficiaries Age 75 to 84 | 527 |
| Number Of Beneficiaries Age Greater 84 | 308 |
| Number Of Female Beneficiaries | 1146 |
| Number Of Male Beneficiaries | 674 |
| Number Of Non Hispanic White Beneficiaries | 1738 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 43 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1291 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 529 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2643 |