| National Provider Identifier [NPI]: | 1538180864 |
| Last Name Of The Provider | WALCZAK |
| First Name Of The Provider | THADDEUS |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5775 WAYZATA BLVD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554161222 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 747 |
| Number Of Medicare Beneficiaries | 217 |
| Total Submitted Charge Amount | 439388.78 |
| Total Medicare Allowed Amount | 139303.09 |
| Total Medicare Payment Amount | 103147.17 |
| Total Medicare Standardized Payment Amount | 109197.56 |
| 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 | 27 |
| Number Of Medical Services | 747 |
| Number Of Medicare Beneficiaries With Medical Services | 217 |
| Total Medical Submitted Charge Amount | 439388.78 |
| Total Medical Medicare Allowed Amount | 139303.09 |
| Total Medical Medicare Payment Amount | 103147.17 |
| Total Medical Medicare Standardized Payment Amount | 109197.56 |
| Average Age Of Beneficiaries | 53 |
| Number Of Beneficiaries Age Less65 | 179 |
| Number Of Beneficiaries Age 65 to 74 | 18 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 193 |
| 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 | 63 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 154 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 37 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4788 |