| National Provider Identifier [NPI]: | 1780685404 |
| Last Name Of The Provider | NIENDORF |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3300 OAKDALE AVE N |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROBBINSDALE |
| Zip Code Of The Provider | 554222926 |
| 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 | 104 |
| Number Of Services | 23413 |
| Number Of Medicare Beneficiaries | 1235 |
| Total Submitted Charge Amount | 1119830.22 |
| Total Medicare Allowed Amount | 209661.01 |
| Total Medicare Payment Amount | 162106.6 |
| Total Medicare Standardized Payment Amount | 176328.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 20904 |
| Number Of Medicare Beneficiaries With Drug Services | 185 |
| Total Drug Submitted ChargeAmount | 20460.22 |
| Total Drug Medicare AllowedAmount | 6257.82 |
| Total Drug Medicare PaymentAmount | 4809.69 |
| Total Drug Medicare Standardized Payment Amount | 4809.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 2509 |
| Number Of Medicare Beneficiaries With Medical Services | 1235 |
| Total Medical Submitted Charge Amount | 1099370 |
| Total Medical Medicare Allowed Amount | 203403.19 |
| Total Medical Medicare Payment Amount | 157296.91 |
| Total Medical Medicare Standardized Payment Amount | 171518.61 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 587 |
| Number Of Beneficiaries Age 65 to 74 | 370 |
| Number Of Beneficiaries Age 75 to 84 | 196 |
| Number Of Beneficiaries Age Greater 84 | 82 |
| Number Of Female Beneficiaries | 626 |
| Number Of Male Beneficiaries | 609 |
| Number Of Non Hispanic White Beneficiaries | 972 |
| Number Of Black or African American Beneficiaries | 139 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 689 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 546 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.6398 |