| National Provider Identifier [NPI]: | 1780684639 |
| Last Name Of The Provider | DALLE |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 166 19TH STREET SOUTH |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | SARTELL |
| Zip Code Of The Provider | 563772154 |
| 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 | 190 |
| Number Of Services | 7519 |
| Number Of Medicare Beneficiaries | 4114 |
| Total Submitted Charge Amount | 798775 |
| Total Medicare Allowed Amount | 233847.92 |
| Total Medicare Payment Amount | 172085.05 |
| Total Medicare Standardized Payment Amount | 168981.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 7519 |
| Number Of Medicare Beneficiaries With Medical Services | 4114 |
| Total Medical Submitted Charge Amount | 798775 |
| Total Medical Medicare Allowed Amount | 233847.92 |
| Total Medical Medicare Payment Amount | 172085.05 |
| Total Medical Medicare Standardized Payment Amount | 168981.68 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 717 |
| Number Of Beneficiaries Age 65 to 74 | 1474 |
| Number Of Beneficiaries Age 75 to 84 | 1258 |
| Number Of Beneficiaries Age Greater 84 | 665 |
| Number Of Female Beneficiaries | 2469 |
| Number Of Male Beneficiaries | 1645 |
| Number Of Non Hispanic White Beneficiaries | 940 |
| Number Of Black or African American Beneficiaries | 74 |
| Number Of AsianPacific Islander Beneficiaries | 61 |
| Number Of Hispanic Beneficiaries | 3010 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1209 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2905 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8555 |