| National Provider Identifier [NPI]: | 1124070883 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4801 W 81ST ST |
| Street Address 2 Of The Provider | SUITE 108 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554371111 |
| 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 | 118 |
| Number Of Services | 10365 |
| Number Of Medicare Beneficiaries | 1230 |
| Total Submitted Charge Amount | 550231.4 |
| Total Medicare Allowed Amount | 171909.37 |
| Total Medicare Payment Amount | 130435.02 |
| Total Medicare Standardized Payment Amount | 136393.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 8700 |
| Number Of Medicare Beneficiaries With Drug Services | 88 |
| Total Drug Submitted ChargeAmount | 2996.4 |
| Total Drug Medicare AllowedAmount | 1712.32 |
| Total Drug Medicare PaymentAmount | 1342.46 |
| Total Drug Medicare Standardized Payment Amount | 1342.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 1665 |
| Number Of Medicare Beneficiaries With Medical Services | 1230 |
| Total Medical Submitted Charge Amount | 547235 |
| Total Medical Medicare Allowed Amount | 170197.05 |
| Total Medical Medicare Payment Amount | 129092.56 |
| Total Medical Medicare Standardized Payment Amount | 135050.67 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 299 |
| Number Of Beneficiaries Age 65 to 74 | 348 |
| Number Of Beneficiaries Age 75 to 84 | 377 |
| Number Of Beneficiaries Age Greater 84 | 206 |
| Number Of Female Beneficiaries | 737 |
| Number Of Male Beneficiaries | 493 |
| Number Of Non Hispanic White Beneficiaries | 1121 |
| Number Of Black or African American Beneficiaries | 65 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 903 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 327 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.7139 |