| National Provider Identifier [NPI]: | 1922282458 |
| Last Name Of The Provider | BERESFORD |
| First Name Of The Provider | ZACH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E 3RD ST |
| Street Address 2 Of The Provider | ESSENTIA HEALTH DULUTH CLINIC |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558051951 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 548 |
| Number Of Medicare Beneficiaries | 176 |
| Total Submitted Charge Amount | 422192 |
| Total Medicare Allowed Amount | 45906.44 |
| Total Medicare Payment Amount | 34877.09 |
| Total Medicare Standardized Payment Amount | 31549.24 |
| 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 | 32 |
| Number Of Medical Services | 548 |
| Number Of Medicare Beneficiaries With Medical Services | 176 |
| Total Medical Submitted Charge Amount | 422192 |
| Total Medical Medicare Allowed Amount | 45906.44 |
| Total Medical Medicare Payment Amount | 34877.09 |
| Total Medical Medicare Standardized Payment Amount | 31549.24 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 165 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 119 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1611 |