| National Provider Identifier [NPI]: | 1194764837 |
| Last Name Of The Provider | BERGSTROM |
| First Name Of The Provider | KENDRA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8435 SE 68TH ST |
| Street Address 2 Of The Provider | SUITE 118 |
| City Of The Provider | MERCER ISLAND |
| Zip Code Of The Provider | 980405249 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 1330 |
| Number Of Medicare Beneficiaries | 224 |
| Total Submitted Charge Amount | 97672.42 |
| Total Medicare Allowed Amount | 88387.36 |
| Total Medicare Payment Amount | 64201.61 |
| Total Medicare Standardized Payment Amount | 59030.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 177 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 565.9 |
| Total Drug Medicare AllowedAmount | 561.87 |
| Total Drug Medicare PaymentAmount | 428.35 |
| Total Drug Medicare Standardized Payment Amount | 428.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 1153 |
| Number Of Medicare Beneficiaries With Medical Services | 224 |
| Total Medical Submitted Charge Amount | 97106.52 |
| Total Medical Medicare Allowed Amount | 87825.49 |
| Total Medical Medicare Payment Amount | 63773.26 |
| Total Medical Medicare Standardized Payment Amount | 58602.36 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 100 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8935 |