| National Provider Identifier [NPI]: | 1780773531 |
| Last Name Of The Provider | BUTWINICK |
| First Name Of The Provider | CONRAD |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17 W EXCHANGE ST |
| Street Address 2 Of The Provider | SUITE 420 |
| City Of The Provider | ST PAUL |
| Zip Code Of The Provider | 551021035 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 51863 |
| Number Of Medicare Beneficiaries | 138 |
| Total Submitted Charge Amount | 1544711 |
| Total Medicare Allowed Amount | 805382.28 |
| Total Medicare Payment Amount | 626647.08 |
| Total Medicare Standardized Payment Amount | 625576.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 50571 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 1396755 |
| Total Drug Medicare AllowedAmount | 747157.75 |
| Total Drug Medicare PaymentAmount | 583445.8 |
| Total Drug Medicare Standardized Payment Amount | 583445.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 1292 |
| Number Of Medicare Beneficiaries With Medical Services | 138 |
| Total Medical Submitted Charge Amount | 147956 |
| Total Medical Medicare Allowed Amount | 58224.53 |
| Total Medical Medicare Payment Amount | 43201.28 |
| Total Medical Medicare Standardized Payment Amount | 42130.61 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.068 |