| National Provider Identifier [NPI]: | 1710953864 |
| Last Name Of The Provider | MEDINA |
| First Name Of The Provider | ANGELA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 401 PHALEN BLVD |
| Street Address 2 Of The Provider | MS 41103F |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551305302 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 1880 |
| Number Of Medicare Beneficiaries | 274 |
| Total Submitted Charge Amount | 155587 |
| Total Medicare Allowed Amount | 58060.21 |
| Total Medicare Payment Amount | 42841.95 |
| Total Medicare Standardized Payment Amount | 44056.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 856 |
| Number Of Medicare Beneficiaries With Drug Services | 75 |
| Total Drug Submitted ChargeAmount | 4584 |
| Total Drug Medicare AllowedAmount | 2580.03 |
| Total Drug Medicare PaymentAmount | 2259.37 |
| Total Drug Medicare Standardized Payment Amount | 2259.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 1024 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 151003 |
| Total Medical Medicare Allowed Amount | 55480.18 |
| Total Medical Medicare Payment Amount | 40582.58 |
| Total Medical Medicare Standardized Payment Amount | 41797.58 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 149 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 165 |
| Number Of Male Beneficiaries | 109 |
| Number Of Non Hispanic White Beneficiaries | 173 |
| Number Of Black or African American Beneficiaries | 76 |
| 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 | 96 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 178 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 25 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7306 |