| National Provider Identifier [NPI]: | 1851378780 |
| Last Name Of The Provider | WORONZOFF-DASHKOFF |
| First Name Of The Provider | HILARION |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14000 FAIRVIEW DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BURNSVILLE |
| Zip Code Of The Provider | 553375713 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 919 |
| Number Of Medicare Beneficiaries | 216 |
| Total Submitted Charge Amount | 84368 |
| Total Medicare Allowed Amount | 35272.84 |
| Total Medicare Payment Amount | 25210.27 |
| Total Medicare Standardized Payment Amount | 26494.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 381 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 5789 |
| Total Drug Medicare AllowedAmount | 2219.14 |
| Total Drug Medicare PaymentAmount | 1728.74 |
| Total Drug Medicare Standardized Payment Amount | 1728.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 538 |
| Number Of Medicare Beneficiaries With Medical Services | 216 |
| Total Medical Submitted Charge Amount | 78579 |
| Total Medical Medicare Allowed Amount | 33053.7 |
| Total Medical Medicare Payment Amount | 23481.53 |
| Total Medical Medicare Standardized Payment Amount | 24765.51 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | 64 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 134 |
| Number Of Male Beneficiaries | 82 |
| 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 | 189 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9707 |