| National Provider Identifier [NPI]: | 1447424882 |
| Last Name Of The Provider | STAVIG |
| First Name Of The Provider | CHRISTINA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5320 HYLAND GREENS DR |
| Street Address 2 Of The Provider | PARK NICOLLET CLINIC - BLOOMINGTON |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 554373938 |
| 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 | 29 |
| Number Of Services | 605 |
| Number Of Medicare Beneficiaries | 95 |
| Total Submitted Charge Amount | 47122.87 |
| Total Medicare Allowed Amount | 20832.66 |
| Total Medicare Payment Amount | 14766.72 |
| Total Medicare Standardized Payment Amount | 15086.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 176 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 908 |
| Total Drug Medicare AllowedAmount | 558.63 |
| Total Drug Medicare PaymentAmount | 537.66 |
| Total Drug Medicare Standardized Payment Amount | 537.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 429 |
| Number Of Medicare Beneficiaries With Medical Services | 95 |
| Total Medical Submitted Charge Amount | 46214.87 |
| Total Medical Medicare Allowed Amount | 20274.03 |
| Total Medical Medicare Payment Amount | 14229.06 |
| Total Medical Medicare Standardized Payment Amount | 14548.97 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 20 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 79 |
| Number Of Male Beneficiaries | 16 |
| 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 | 61 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 33 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0098 |