| National Provider Identifier [NPI]: | 1831140441 |
| Last Name Of The Provider | BULLIS |
| First Name Of The Provider | BRENT |
| Middle Initial Of The Provider | R |
| 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 | 133 |
| Number Of Services | 2951 |
| Number Of Medicare Beneficiaries | 2228 |
| Total Submitted Charge Amount | 318011.2 |
| Total Medicare Allowed Amount | 109068.28 |
| Total Medicare Payment Amount | 82472.26 |
| Total Medicare Standardized Payment Amount | 85795.9 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 558 |
| Number Of Beneficiaries Age 65 to 74 | 669 |
| Number Of Beneficiaries Age 75 to 84 | 624 |
| Number Of Beneficiaries Age Greater 84 | 377 |
| Number Of Female Beneficiaries | 1219 |
| Number Of Male Beneficiaries | 1009 |
| Number Of Non Hispanic White Beneficiaries | 1993 |
| Number Of Black or African American Beneficiaries | 127 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 36 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1535 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 693 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7266 |