| National Provider Identifier [NPI]: | 1740459551 |
| Last Name Of The Provider | BRYAN |
| First Name Of The Provider | ERICH |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 166 4TH ST E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551011421 |
| 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 | 54 |
| Number Of Services | 4717 |
| Number Of Medicare Beneficiaries | 1796 |
| Total Submitted Charge Amount | 662422.14 |
| Total Medicare Allowed Amount | 177949.03 |
| Total Medicare Payment Amount | 135422.32 |
| Total Medicare Standardized Payment Amount | 141791.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2302 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 10720 |
| Total Drug Medicare AllowedAmount | 1233.63 |
| Total Drug Medicare PaymentAmount | 967.18 |
| Total Drug Medicare Standardized Payment Amount | 967.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 2415 |
| Number Of Medicare Beneficiaries With Medical Services | 1795 |
| Total Medical Submitted Charge Amount | 651702.14 |
| Total Medical Medicare Allowed Amount | 176715.4 |
| Total Medical Medicare Payment Amount | 134455.14 |
| Total Medical Medicare Standardized Payment Amount | 140824.45 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 428 |
| Number Of Beneficiaries Age 65 to 74 | 542 |
| Number Of Beneficiaries Age 75 to 84 | 489 |
| Number Of Beneficiaries Age Greater 84 | 337 |
| Number Of Female Beneficiaries | 1022 |
| Number Of Male Beneficiaries | 774 |
| Number Of Non Hispanic White Beneficiaries | 1598 |
| Number Of Black or African American Beneficiaries | 90 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| 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 | 1315 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 481 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 1.4857 |