| National Provider Identifier [NPI]: | 1912983982 |
| Last Name Of The Provider | POULTON |
| First Name Of The Provider | JEANNE |
| 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 | 1500 CURVE CREST BLVD W |
| Street Address 2 Of The Provider | |
| 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 | 34 |
| Number Of Services | 491 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 56112.37 |
| Total Medicare Allowed Amount | 22640.93 |
| Total Medicare Payment Amount | 15705.32 |
| Total Medicare Standardized Payment Amount | 16026.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 1240.37 |
| Total Drug Medicare AllowedAmount | 1097.91 |
| Total Drug Medicare PaymentAmount | 1071.76 |
| Total Drug Medicare Standardized Payment Amount | 1071.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 466 |
| Number Of Medicare Beneficiaries With Medical Services | 157 |
| Total Medical Submitted Charge Amount | 54872 |
| Total Medical Medicare Allowed Amount | 21543.02 |
| Total Medical Medicare Payment Amount | 14633.56 |
| Total Medical Medicare Standardized Payment Amount | 14954.45 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 107 |
| Number Of Male Beneficiaries | 50 |
| 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 | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 27 |
| Percent Of With Hypertension | 36 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9607 |