| National Provider Identifier [NPI]: | 1104863679 |
| Last Name Of The Provider | STOLDT |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2930 W CLEVELAND RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 466286090 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 1425 |
| Number Of Medicare Beneficiaries | 228 |
| Total Submitted Charge Amount | 159721.5 |
| Total Medicare Allowed Amount | 95652.92 |
| Total Medicare Payment Amount | 67432.1 |
| Total Medicare Standardized Payment Amount | 72520.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 82 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 2176 |
| Total Drug Medicare AllowedAmount | 1345.19 |
| Total Drug Medicare PaymentAmount | 1287.58 |
| Total Drug Medicare Standardized Payment Amount | 1287.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 1343 |
| Number Of Medicare Beneficiaries With Medical Services | 228 |
| Total Medical Submitted Charge Amount | 157545.5 |
| Total Medical Medicare Allowed Amount | 94307.73 |
| Total Medical Medicare Payment Amount | 66144.52 |
| Total Medical Medicare Standardized Payment Amount | 71233.01 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 115 |
| Number Of Non Hispanic White Beneficiaries | 198 |
| 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 | 172 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0903 |