| National Provider Identifier [NPI]: | 1942232327 |
| Last Name Of The Provider | WITRAK |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E 3RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558051951 |
| 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 | 193 |
| Number Of Services | 4813 |
| Number Of Medicare Beneficiaries | 2752 |
| Total Submitted Charge Amount | 700356.9 |
| Total Medicare Allowed Amount | 135412.19 |
| Total Medicare Payment Amount | 101285.06 |
| Total Medicare Standardized Payment Amount | 104830.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 349 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 4733.9 |
| Total Drug Medicare AllowedAmount | 672.6 |
| Total Drug Medicare PaymentAmount | 527.3 |
| Total Drug Medicare Standardized Payment Amount | 527.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 4464 |
| Number Of Medicare Beneficiaries With Medical Services | 2747 |
| Total Medical Submitted Charge Amount | 695623 |
| Total Medical Medicare Allowed Amount | 134739.59 |
| Total Medical Medicare Payment Amount | 100757.76 |
| Total Medical Medicare Standardized Payment Amount | 104303.04 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 789 |
| Number Of Beneficiaries Age 65 to 74 | 829 |
| Number Of Beneficiaries Age 75 to 84 | 686 |
| Number Of Beneficiaries Age Greater 84 | 448 |
| Number Of Female Beneficiaries | 1540 |
| Number Of Male Beneficiaries | 1212 |
| Number Of Non Hispanic White Beneficiaries | 2546 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 130 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1750 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1002 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5727 |