| National Provider Identifier [NPI]: | 1679715130 |
| Last Name Of The Provider | SHOTTS |
| First Name Of The Provider | EZEKIEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 1ST ST SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCHESTER |
| Zip Code Of The Provider | 559050001 |
| 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 | 124 |
| Number Of Services | 3384 |
| Number Of Medicare Beneficiaries | 1127 |
| Total Submitted Charge Amount | 146984.84 |
| Total Medicare Allowed Amount | 69952.77 |
| Total Medicare Payment Amount | 51536.21 |
| Total Medicare Standardized Payment Amount | 56934.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 840 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 1423.66 |
| Total Drug Medicare AllowedAmount | 1174.12 |
| Total Drug Medicare PaymentAmount | 836.46 |
| Total Drug Medicare Standardized Payment Amount | 836.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 2544 |
| Number Of Medicare Beneficiaries With Medical Services | 1127 |
| Total Medical Submitted Charge Amount | 145561.18 |
| Total Medical Medicare Allowed Amount | 68778.65 |
| Total Medical Medicare Payment Amount | 50699.75 |
| Total Medical Medicare Standardized Payment Amount | 56097.8 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 197 |
| Number Of Beneficiaries Age 65 to 74 | 447 |
| Number Of Beneficiaries Age 75 to 84 | 326 |
| Number Of Beneficiaries Age Greater 84 | 157 |
| Number Of Female Beneficiaries | 654 |
| Number Of Male Beneficiaries | 473 |
| Number Of Non Hispanic White Beneficiaries | 1086 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 934 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 193 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2985 |