| National Provider Identifier [NPI]: | 1114972221 |
| Last Name Of The Provider | OFFICER |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 705 PLEASANT AVE S |
| Street Address 2 Of The Provider | |
| City Of The Provider | PARK RAPIDS |
| Zip Code Of The Provider | 564701440 |
| 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 | 59 |
| Number Of Services | 965 |
| Number Of Medicare Beneficiaries | 164 |
| Total Submitted Charge Amount | 109661 |
| Total Medicare Allowed Amount | 45367.81 |
| Total Medicare Payment Amount | 31745.79 |
| Total Medicare Standardized Payment Amount | 32381.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 288 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 16704 |
| Total Drug Medicare AllowedAmount | 11594.26 |
| Total Drug Medicare PaymentAmount | 9087.93 |
| Total Drug Medicare Standardized Payment Amount | 9087.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 677 |
| Number Of Medicare Beneficiaries With Medical Services | 164 |
| Total Medical Submitted Charge Amount | 92957 |
| Total Medical Medicare Allowed Amount | 33773.55 |
| Total Medical Medicare Payment Amount | 22657.86 |
| Total Medical Medicare Standardized Payment Amount | 23293.24 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 77 |
| Number Of Male Beneficiaries | 87 |
| 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 | 104 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3667 |