| National Provider Identifier [NPI]: | 1174509137 |
| Last Name Of The Provider | CARLSON |
| First Name Of The Provider | GEORGINA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 CURVE CREST BOULEVARD |
| Street Address 2 Of The Provider | STILLWATER MEDICAL GROUP |
| City Of The Provider | STILLWATER |
| Zip Code Of The Provider | 550826040 |
| 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 | 45 |
| Number Of Services | 828 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 105098.3 |
| Total Medicare Allowed Amount | 42506.83 |
| Total Medicare Payment Amount | 30580.4 |
| Total Medicare Standardized Payment Amount | 31792.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 2406 |
| Total Drug Medicare AllowedAmount | 2160.49 |
| Total Drug Medicare PaymentAmount | 2048.12 |
| Total Drug Medicare Standardized Payment Amount | 2048.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 755 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 102692.3 |
| Total Medical Medicare Allowed Amount | 40346.34 |
| Total Medical Medicare Payment Amount | 28532.28 |
| Total Medical Medicare Standardized Payment Amount | 29744.81 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 149 |
| Number Of Male Beneficiaries | 19 |
| 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 | 133 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 15 |
| Percent Of With Hypertension | 24 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8352 |