| National Provider Identifier [NPI]: | 1255523221 |
| Last Name Of The Provider | JAGADEESAN |
| First Name Of The Provider | BHARATHIDASAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 420 DELAWARE STREET |
| Street Address 2 Of The Provider | MMC 292, MAYO MEMORIAL BUILDING |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 55455 |
| 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 | 64 |
| Number Of Services | 1444 |
| Number Of Medicare Beneficiaries | 84 |
| Total Submitted Charge Amount | 369501 |
| Total Medicare Allowed Amount | 63401.34 |
| Total Medicare Payment Amount | 49447.81 |
| Total Medicare Standardized Payment Amount | 49243.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1091 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 571 |
| Total Drug Medicare AllowedAmount | 354.46 |
| Total Drug Medicare PaymentAmount | 277.88 |
| Total Drug Medicare Standardized Payment Amount | 277.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 353 |
| Number Of Medicare Beneficiaries With Medical Services | 84 |
| Total Medical Submitted Charge Amount | 368930 |
| Total Medical Medicare Allowed Amount | 63046.88 |
| Total Medical Medicare Payment Amount | 49169.93 |
| Total Medical Medicare Standardized Payment Amount | 48965.31 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 21 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 42 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | 70 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 52 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 36 |
| Average HCC Risk Score Of Beneficiaries | 1.93 |