| National Provider Identifier [NPI]: | 1003893520 |
| Last Name Of The Provider | SHULTZ |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6500 EXCELSIOR BLVD |
| Street Address 2 Of The Provider | PARK NICOLLET CLINIC - HEART & VASCULAR CENTER |
| City Of The Provider | ST LOUIS PARK |
| Zip Code Of The Provider | 554264702 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Electrophysiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 2205 |
| Number Of Medicare Beneficiaries | 1091 |
| Total Submitted Charge Amount | 430979.08 |
| Total Medicare Allowed Amount | 150454.67 |
| Total Medicare Payment Amount | 110309.8 |
| Total Medicare Standardized Payment Amount | 115877.57 |
| Drug Suppress Indicator | * |
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| Number Of Medicare Beneficiaries With Drug Services | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 109 |
| Number Of Beneficiaries Age 65 to 74 | 244 |
| Number Of Beneficiaries Age 75 to 84 | 387 |
| Number Of Beneficiaries Age Greater 84 | 351 |
| Number Of Female Beneficiaries | 542 |
| Number Of Male Beneficiaries | 549 |
| Number Of Non Hispanic White Beneficiaries | 1020 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| 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 | 962 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 43 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.57 |