| National Provider Identifier [NPI]: | 1477616449 |
| Last Name Of The Provider | WOLFSON |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5955 GOLDEN VALLEY RD STE 108 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GOLDEN VALLEY |
| Zip Code Of The Provider | 554224450 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 1664 |
| Number Of Medicare Beneficiaries | 1281 |
| Total Submitted Charge Amount | 242585 |
| Total Medicare Allowed Amount | 186234.69 |
| Total Medicare Payment Amount | 141281.46 |
| Total Medicare Standardized Payment Amount | 143130 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 1664 |
| Number Of Medicare Beneficiaries With Medical Services | 1281 |
| Total Medical Submitted Charge Amount | 242585 |
| Total Medical Medicare Allowed Amount | 186234.69 |
| Total Medical Medicare Payment Amount | 141281.46 |
| Total Medical Medicare Standardized Payment Amount | 143130 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | 186 |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 284 |
| Number Of Beneficiaries Age Greater 84 | 623 |
| Number Of Female Beneficiaries | 838 |
| Number Of Male Beneficiaries | 443 |
| Number Of Non Hispanic White Beneficiaries | 1148 |
| Number Of Black or African American Beneficiaries | 84 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 437 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 844 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 73 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 27 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.2144 |