| National Provider Identifier [NPI]: | 1336153725 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | JONATHAN |
| 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 | 1245 15TH ST N |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT CLOUD |
| Zip Code Of The Provider | 563031802 |
| 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 | 89 |
| Number Of Services | 1827 |
| Number Of Medicare Beneficiaries | 169 |
| Total Submitted Charge Amount | 99508 |
| Total Medicare Allowed Amount | 37125.89 |
| Total Medicare Payment Amount | 27463.08 |
| Total Medicare Standardized Payment Amount | 26688.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 912 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 4806 |
| Total Drug Medicare AllowedAmount | 2317.49 |
| Total Drug Medicare PaymentAmount | 1936.24 |
| Total Drug Medicare Standardized Payment Amount | 1936.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 915 |
| Number Of Medicare Beneficiaries With Medical Services | 169 |
| Total Medical Submitted Charge Amount | 94702 |
| Total Medical Medicare Allowed Amount | 34808.4 |
| Total Medical Medicare Payment Amount | 25526.84 |
| Total Medical Medicare Standardized Payment Amount | 24752.3 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 80 |
| Number Of Male Beneficiaries | 89 |
| Number Of Non Hispanic White Beneficiaries | 145 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 73 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 24 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0674 |