| National Provider Identifier [NPI]: | 1881673218 |
| Last Name Of The Provider | PASSE |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 166 4TH ST E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551011421 |
| 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 | 47 |
| Number Of Services | 2741 |
| Number Of Medicare Beneficiaries | 1071 |
| Total Submitted Charge Amount | 474796.87 |
| Total Medicare Allowed Amount | 125877.23 |
| Total Medicare Payment Amount | 95206.1 |
| Total Medicare Standardized Payment Amount | 99897.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1199 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 5407 |
| Total Drug Medicare AllowedAmount | 832.97 |
| Total Drug Medicare PaymentAmount | 653.03 |
| Total Drug Medicare Standardized Payment Amount | 653.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 1542 |
| Number Of Medicare Beneficiaries With Medical Services | 1071 |
| Total Medical Submitted Charge Amount | 469389.87 |
| Total Medical Medicare Allowed Amount | 125044.26 |
| Total Medical Medicare Payment Amount | 94553.07 |
| Total Medical Medicare Standardized Payment Amount | 99244.89 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 258 |
| Number Of Beneficiaries Age 65 to 74 | 308 |
| Number Of Beneficiaries Age 75 to 84 | 305 |
| Number Of Beneficiaries Age Greater 84 | 200 |
| Number Of Female Beneficiaries | 642 |
| Number Of Male Beneficiaries | 429 |
| Number Of Non Hispanic White Beneficiaries | 939 |
| Number Of Black or African American Beneficiaries | 49 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 778 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 293 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 23 |
| Average HCC Risk Score Of Beneficiaries | 1.4002 |