| National Provider Identifier [NPI]: | 1215942180 |
| Last Name Of The Provider | DUTHOY |
| First Name Of The Provider | DALE |
| 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 | 4786 BANNING AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WHITE BEAR LAKE |
| Zip Code Of The Provider | 551103264 |
| 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 | 74 |
| Number Of Services | 1730 |
| Number Of Medicare Beneficiaries | 212 |
| Total Submitted Charge Amount | 104966 |
| Total Medicare Allowed Amount | 56400.33 |
| Total Medicare Payment Amount | 39530.78 |
| Total Medicare Standardized Payment Amount | 41697.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 561 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 5584 |
| Total Drug Medicare AllowedAmount | 4572.14 |
| Total Drug Medicare PaymentAmount | 4225.62 |
| Total Drug Medicare Standardized Payment Amount | 4225.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 1169 |
| Number Of Medicare Beneficiaries With Medical Services | 212 |
| Total Medical Submitted Charge Amount | 99382 |
| Total Medical Medicare Allowed Amount | 51828.19 |
| Total Medical Medicare Payment Amount | 35305.16 |
| Total Medical Medicare Standardized Payment Amount | 37471.39 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 52 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 99 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 159 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0353 |