| National Provider Identifier [NPI]: | 1013066745 |
| Last Name Of The Provider | MOSTROM |
| First Name Of The Provider | DAN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3231 S NATIONAL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 658077304 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 3863 |
| Number Of Medicare Beneficiaries | 448 |
| Total Submitted Charge Amount | 568399.3 |
| Total Medicare Allowed Amount | 227661.26 |
| Total Medicare Payment Amount | 168962.86 |
| Total Medicare Standardized Payment Amount | 181491.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1366 |
| Number Of Medicare Beneficiaries With Drug Services | 154 |
| Total Drug Submitted ChargeAmount | 57216 |
| Total Drug Medicare AllowedAmount | 37233.95 |
| Total Drug Medicare PaymentAmount | 29181.5 |
| Total Drug Medicare Standardized Payment Amount | 29181.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 2497 |
| Number Of Medicare Beneficiaries With Medical Services | 448 |
| Total Medical Submitted Charge Amount | 511183.3 |
| Total Medical Medicare Allowed Amount | 190427.31 |
| Total Medical Medicare Payment Amount | 139781.36 |
| Total Medical Medicare Standardized Payment Amount | 152309.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 220 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 304 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | 436 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 398 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3597 |