| National Provider Identifier [NPI]: | 1780684126 |
| Last Name Of The Provider | SIMONSON |
| First Name Of The Provider | TEREASA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1406 6TH AVE N |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT CLOUD |
| Zip Code Of The Provider | 563031900 |
| 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 | 160 |
| Number Of Services | 15177 |
| Number Of Medicare Beneficiaries | 2011 |
| Total Submitted Charge Amount | 3320115.84 |
| Total Medicare Allowed Amount | 1063728.99 |
| Total Medicare Payment Amount | 830268.14 |
| Total Medicare Standardized Payment Amount | 771842.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 11528 |
| Number Of Medicare Beneficiaries With Drug Services | 234 |
| Total Drug Submitted ChargeAmount | 21298 |
| Total Drug Medicare AllowedAmount | 6700.32 |
| Total Drug Medicare PaymentAmount | 4891.64 |
| Total Drug Medicare Standardized Payment Amount | 4891.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 156 |
| Number Of Medical Services | 3649 |
| Number Of Medicare Beneficiaries With Medical Services | 2011 |
| Total Medical Submitted Charge Amount | 3298817.84 |
| Total Medical Medicare Allowed Amount | 1057028.67 |
| Total Medical Medicare Payment Amount | 825376.5 |
| Total Medical Medicare Standardized Payment Amount | 766950.97 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 338 |
| Number Of Beneficiaries Age 65 to 74 | 996 |
| Number Of Beneficiaries Age 75 to 84 | 515 |
| Number Of Beneficiaries Age Greater 84 | 162 |
| Number Of Female Beneficiaries | 1303 |
| Number Of Male Beneficiaries | 708 |
| Number Of Non Hispanic White Beneficiaries | 1135 |
| Number Of Black or African American Beneficiaries | 237 |
| Number Of AsianPacific Islander Beneficiaries | 316 |
| Number Of Hispanic Beneficiaries | 262 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1291 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 720 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1687 |