| National Provider Identifier [NPI]: | 1063493781 |
| Last Name Of The Provider | GROSS |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 EAST BROADWAY |
| Street Address 2 Of The Provider | AFFILIATED COMMUNITY MEDICAL CENTERS |
| City Of The Provider | REDWOOD FALLS |
| Zip Code Of The Provider | 56283 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 631 |
| Number Of Medicare Beneficiaries | 119 |
| Total Submitted Charge Amount | 26389.33 |
| Total Medicare Allowed Amount | 12470.11 |
| Total Medicare Payment Amount | 9359.69 |
| Total Medicare Standardized Payment Amount | 9615.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 421 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 2747.78 |
| Total Drug Medicare AllowedAmount | 1521.56 |
| Total Drug Medicare PaymentAmount | 1194.54 |
| Total Drug Medicare Standardized Payment Amount | 1194.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 210 |
| Number Of Medicare Beneficiaries With Medical Services | 119 |
| Total Medical Submitted Charge Amount | 23641.55 |
| Total Medical Medicare Allowed Amount | 10948.55 |
| Total Medical Medicare Payment Amount | 8165.15 |
| Total Medical Medicare Standardized Payment Amount | 8421.34 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 30 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 66 |
| Number Of Male Beneficiaries | 53 |
| 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 | 96 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4561 |