| National Provider Identifier [NPI]: | 1477662088 |
| Last Name Of The Provider | SHEN |
| First Name Of The Provider | MAOXING |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11475 ROBINSON DR NW |
| Street Address 2 Of The Provider | MAIL STOP 32600A |
| City Of The Provider | COON RAPID |
| Zip Code Of The Provider | 554333746 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 722 |
| Number Of Medicare Beneficiaries | 116 |
| Total Submitted Charge Amount | 98621 |
| Total Medicare Allowed Amount | 35678.52 |
| Total Medicare Payment Amount | 25544.94 |
| Total Medicare Standardized Payment Amount | 26377.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 1319 |
| Total Drug Medicare AllowedAmount | 638.4 |
| Total Drug Medicare PaymentAmount | 617.7 |
| Total Drug Medicare Standardized Payment Amount | 617.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 665 |
| Number Of Medicare Beneficiaries With Medical Services | 116 |
| Total Medical Submitted Charge Amount | 97302 |
| Total Medical Medicare Allowed Amount | 35040.12 |
| Total Medical Medicare Payment Amount | 24927.24 |
| Total Medical Medicare Standardized Payment Amount | 25759.58 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 62 |
| Number Of Male Beneficiaries | 54 |
| Number Of Non Hispanic White Beneficiaries | 92 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 69 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0063 |