| National Provider Identifier [NPI]: | 1659316891 |
| Last Name Of The Provider | TJADEN |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1301 33RD ST S |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT CLOUD |
| Zip Code Of The Provider | 563019668 |
| 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 | 121 |
| Number Of Services | 1979 |
| Number Of Medicare Beneficiaries | 156 |
| Total Submitted Charge Amount | 120963.96 |
| Total Medicare Allowed Amount | 62865 |
| Total Medicare Payment Amount | 49924.63 |
| Total Medicare Standardized Payment Amount | 50827.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 267 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 9027 |
| Total Drug Medicare AllowedAmount | 6260.3 |
| Total Drug Medicare PaymentAmount | 5494.3 |
| Total Drug Medicare Standardized Payment Amount | 5494.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 1712 |
| Number Of Medicare Beneficiaries With Medical Services | 156 |
| Total Medical Submitted Charge Amount | 111936.96 |
| Total Medical Medicare Allowed Amount | 56604.7 |
| Total Medical Medicare Payment Amount | 44430.33 |
| Total Medical Medicare Standardized Payment Amount | 45333.21 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 37 |
| 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 | 107 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| 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 | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 10 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9056 |