| National Provider Identifier [NPI]: | 1508891227 |
| Last Name Of The Provider | LOES |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | |
| 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 | BLOOMINGTON |
| 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 | 114 |
| Number Of Services | 4246 |
| Number Of Medicare Beneficiaries | 1827 |
| Total Submitted Charge Amount | 435996.18 |
| Total Medicare Allowed Amount | 138545.57 |
| Total Medicare Payment Amount | 104642.5 |
| Total Medicare Standardized Payment Amount | 109618.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1463 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 1271.18 |
| Total Drug Medicare AllowedAmount | 970.8 |
| Total Drug Medicare PaymentAmount | 739.16 |
| Total Drug Medicare Standardized Payment Amount | 739.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 112 |
| Number Of Medical Services | 2783 |
| Number Of Medicare Beneficiaries With Medical Services | 1827 |
| Total Medical Submitted Charge Amount | 434725 |
| Total Medical Medicare Allowed Amount | 137574.77 |
| Total Medical Medicare Payment Amount | 103903.34 |
| Total Medical Medicare Standardized Payment Amount | 108878.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 482 |
| Number Of Beneficiaries Age 65 to 74 | 407 |
| Number Of Beneficiaries Age 75 to 84 | 511 |
| Number Of Beneficiaries Age Greater 84 | 427 |
| Number Of Female Beneficiaries | 1069 |
| Number Of Male Beneficiaries | 758 |
| Number Of Non Hispanic White Beneficiaries | 1667 |
| Number Of Black or African American Beneficiaries | 79 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1272 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 555 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.6652 |