| National Provider Identifier [NPI]: | 1053571109 |
| Last Name Of The Provider | SANN |
| First Name Of The Provider | KATE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 530 3RD ST NW |
| Street Address 2 Of The Provider | RIVERWAY CLINIC-ELK RIVER-MAIL STOP 39400A |
| City Of The Provider | ELK RIVER |
| Zip Code Of The Provider | 553308863 |
| 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 | 51 |
| Number Of Services | 362 |
| Number Of Medicare Beneficiaries | 117 |
| Total Submitted Charge Amount | 50113 |
| Total Medicare Allowed Amount | 18290.27 |
| Total Medicare Payment Amount | 11936.33 |
| Total Medicare Standardized Payment Amount | 12949.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 89 |
| Total Drug Medicare AllowedAmount | 67.73 |
| Total Drug Medicare PaymentAmount | 61.91 |
| Total Drug Medicare Standardized Payment Amount | 61.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 334 |
| Number Of Medicare Beneficiaries With Medical Services | 117 |
| Total Medical Submitted Charge Amount | 50024 |
| Total Medical Medicare Allowed Amount | 18222.54 |
| Total Medical Medicare Payment Amount | 11874.42 |
| Total Medical Medicare Standardized Payment Amount | 12887.97 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 79 |
| Number Of Male Beneficiaries | 38 |
| 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 | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| 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 | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 21 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0101 |