| National Provider Identifier [NPI]: | 1699765206 |
| Last Name Of The Provider | DOBERSTEIN |
| First Name Of The Provider | ANN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1873 KORKKI RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558049638 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 200 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 22066.36 |
| Total Medicare Allowed Amount | 10566.15 |
| Total Medicare Payment Amount | 7976.54 |
| Total Medicare Standardized Payment Amount | 8094.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 698 |
| Total Drug Medicare AllowedAmount | 446.26 |
| Total Drug Medicare PaymentAmount | 437.12 |
| Total Drug Medicare Standardized Payment Amount | 437.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 178 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 21368.36 |
| Total Medical Medicare Allowed Amount | 10119.89 |
| Total Medical Medicare Payment Amount | 7539.42 |
| Total Medical Medicare Standardized Payment Amount | 7657 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 20 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 49 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | 72 |
| 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 | 29 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 59 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 26 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1645 |