National Provider Identifier [NPI]: |
1639123508 |
Last Name Of The Provider |
LUNDGREN |
First Name Of The Provider |
CINDY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
919 NORTHLAND DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
PRINCETON |
Zip Code Of The Provider |
553712172 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
9 |
Number Of Services |
146 |
Number Of Medicare Beneficiaries |
86 |
Total Submitted Charge Amount |
7395 |
Total Medicare Allowed Amount |
6549.19 |
Total Medicare Payment Amount |
4190.62 |
Total Medicare Standardized Payment Amount |
5825.98 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
21 |
Number Of Medicare Beneficiaries With Drug Services |
19 |
Total Drug Submitted ChargeAmount |
720 |
Total Drug Medicare AllowedAmount |
680.73 |
Total Drug Medicare PaymentAmount |
667.06 |
Total Drug Medicare Standardized Payment Amount |
667.06 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
7 |
Number Of Medical Services |
125 |
Number Of Medicare Beneficiaries With Medical Services |
84 |
Total Medical Submitted Charge Amount |
6675 |
Total Medical Medicare Allowed Amount |
5868.46 |
Total Medical Medicare Payment Amount |
3523.56 |
Total Medical Medicare Standardized Payment Amount |
5158.92 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
27 |
Number Of Beneficiaries Age 65 to 74 |
37 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
63 |
Number Of Male Beneficiaries |
23 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
66 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
20 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
0 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
29 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
40 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.983 |