| National Provider Identifier [NPI]: | 1023084332 |
| Last Name Of The Provider | MELLEMA |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 WILLMAR AVE SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILLMAR |
| Zip Code Of The Provider | 56201 |
| 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 | 152 |
| Number Of Services | 14134 |
| Number Of Medicare Beneficiaries | 735 |
| Total Submitted Charge Amount | 341512.41 |
| Total Medicare Allowed Amount | 137450.01 |
| Total Medicare Payment Amount | 103922.16 |
| Total Medicare Standardized Payment Amount | 103667.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 33 |
| Number Of Drug Services | 9700 |
| Number Of Medicare Beneficiaries With Drug Services | 139 |
| Total Drug Submitted ChargeAmount | 75081.86 |
| Total Drug Medicare AllowedAmount | 48172.72 |
| Total Drug Medicare PaymentAmount | 37887.37 |
| Total Drug Medicare Standardized Payment Amount | 37887.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 119 |
| Number Of Medical Services | 4434 |
| Number Of Medicare Beneficiaries With Medical Services | 734 |
| Total Medical Submitted Charge Amount | 266430.55 |
| Total Medical Medicare Allowed Amount | 89277.29 |
| Total Medical Medicare Payment Amount | 66034.79 |
| Total Medical Medicare Standardized Payment Amount | 65779.73 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 197 |
| Number Of Beneficiaries Age 65 to 74 | 175 |
| Number Of Beneficiaries Age 75 to 84 | 217 |
| Number Of Beneficiaries Age Greater 84 | 146 |
| Number Of Female Beneficiaries | 414 |
| Number Of Male Beneficiaries | 321 |
| Number Of Non Hispanic White Beneficiaries | 696 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 524 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 211 |
| Percent Of With Atrial Fibrillation | 30 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2374 |