| National Provider Identifier [NPI]: | 1548205891 |
| Last Name Of The Provider | BENSON |
| First Name Of The Provider | MANFERD |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 E SUPERIOR ST |
| Street Address 2 Of The Provider | SUITE 109 |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558022238 |
| 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 | 196 |
| Number Of Services | 4450 |
| Number Of Medicare Beneficiaries | 2390 |
| Total Submitted Charge Amount | 593314 |
| Total Medicare Allowed Amount | 131109.53 |
| Total Medicare Payment Amount | 101932.93 |
| Total Medicare Standardized Payment Amount | 105311.67 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 583 |
| Number Of Beneficiaries Age 65 to 74 | 765 |
| Number Of Beneficiaries Age 75 to 84 | 673 |
| Number Of Beneficiaries Age Greater 84 | 369 |
| Number Of Female Beneficiaries | 1516 |
| Number Of Male Beneficiaries | 874 |
| Number Of Non Hispanic White Beneficiaries | 2276 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 71 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1733 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 657 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1966 |