| National Provider Identifier [NPI]: | 1013904044 |
| Last Name Of The Provider | ERICKSON |
| First Name Of The Provider | MITCHELL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1111 6TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DES MOINES |
| Zip Code Of The Provider | 503142613 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 140 |
| Number Of Services | 5062 |
| Number Of Medicare Beneficiaries | 3430 |
| Total Submitted Charge Amount | 1001655.1 |
| Total Medicare Allowed Amount | 224839.91 |
| Total Medicare Payment Amount | 172763.42 |
| Total Medicare Standardized Payment Amount | 185747.25 |
| 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 | 140 |
| Number Of Medical Services | 5062 |
| Number Of Medicare Beneficiaries With Medical Services | 3430 |
| Total Medical Submitted Charge Amount | 1001655.1 |
| Total Medical Medicare Allowed Amount | 224839.91 |
| Total Medical Medicare Payment Amount | 172763.42 |
| Total Medical Medicare Standardized Payment Amount | 185747.25 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 586 |
| Number Of Beneficiaries Age 65 to 74 | 1216 |
| Number Of Beneficiaries Age 75 to 84 | 1049 |
| Number Of Beneficiaries Age Greater 84 | 579 |
| Number Of Female Beneficiaries | 1966 |
| Number Of Male Beneficiaries | 1464 |
| Number Of Non Hispanic White Beneficiaries | 3228 |
| Number Of Black or African American Beneficiaries | 103 |
| Number Of AsianPacific Islander Beneficiaries | 31 |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2554 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 876 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.5569 |