| National Provider Identifier [NPI]: | 1558567974 |
| Last Name Of The Provider | BUSSELBERG |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5775 WAYZATA BLVD. |
| Street Address 2 Of The Provider | SUITE 190 |
| City Of The Provider | SAINT LOUIS PARK |
| Zip Code Of The Provider | 554162627 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 5067 |
| Number Of Medicare Beneficiaries | 456 |
| Total Submitted Charge Amount | 764710 |
| Total Medicare Allowed Amount | 100763.7 |
| Total Medicare Payment Amount | 76043.35 |
| Total Medicare Standardized Payment Amount | 77374.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 4399 |
| Number Of Medicare Beneficiaries With Drug Services | 179 |
| Total Drug Submitted ChargeAmount | 42632 |
| Total Drug Medicare AllowedAmount | 2346.84 |
| Total Drug Medicare PaymentAmount | 1799.7 |
| Total Drug Medicare Standardized Payment Amount | 1799.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 668 |
| Number Of Medicare Beneficiaries With Medical Services | 456 |
| Total Medical Submitted Charge Amount | 722078 |
| Total Medical Medicare Allowed Amount | 98416.86 |
| Total Medical Medicare Payment Amount | 74243.65 |
| Total Medical Medicare Standardized Payment Amount | 75574.58 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 137 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 62 |
| Number Of Female Beneficiaries | 263 |
| Number Of Male Beneficiaries | 193 |
| Number Of Non Hispanic White Beneficiaries | 401 |
| Number Of Black or African American Beneficiaries | 24 |
| 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 | 343 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1225 |