| National Provider Identifier [NPI]: | 1780670398 |
| Last Name Of The Provider | BERGSTROM |
| First Name Of The Provider | DEBRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 S WHITE MOUNTAIN RD |
| Street Address 2 Of The Provider | SUITE 401 |
| City Of The Provider | SHOW LOW |
| Zip Code Of The Provider | 859017111 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 8292 |
| Number Of Medicare Beneficiaries | 1350 |
| Total Submitted Charge Amount | 453862 |
| Total Medicare Allowed Amount | 321809.81 |
| Total Medicare Payment Amount | 221475.67 |
| Total Medicare Standardized Payment Amount | 266688.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 4840 |
| Total Drug Medicare AllowedAmount | 4544.68 |
| Total Drug Medicare PaymentAmount | 3563.01 |
| Total Drug Medicare Standardized Payment Amount | 3563.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 8265 |
| Number Of Medicare Beneficiaries With Medical Services | 1350 |
| Total Medical Submitted Charge Amount | 449022 |
| Total Medical Medicare Allowed Amount | 317265.13 |
| Total Medical Medicare Payment Amount | 217912.66 |
| Total Medical Medicare Standardized Payment Amount | 263125.77 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 750 |
| Number Of Beneficiaries Age 75 to 84 | 423 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 650 |
| Number Of Male Beneficiaries | 700 |
| Number Of Non Hispanic White Beneficiaries | 1276 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1289 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8811 |