| National Provider Identifier [NPI]: | 1518902998 |
| Last Name Of The Provider | AMON |
| First Name Of The Provider | MARY |
| 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 | 502 2ND ST SW |
| Street Address 2 Of The Provider | SUITE 1 |
| City Of The Provider | WILLMAR |
| Zip Code Of The Provider | 562013365 |
| 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 | 65 |
| Number Of Services | 525 |
| Number Of Medicare Beneficiaries | 52 |
| Total Submitted Charge Amount | 34593 |
| Total Medicare Allowed Amount | 14162.23 |
| Total Medicare Payment Amount | 10157.41 |
| Total Medicare Standardized Payment Amount | 10381.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 164 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 607 |
| Total Drug Medicare AllowedAmount | 443.55 |
| Total Drug Medicare PaymentAmount | 425.5 |
| Total Drug Medicare Standardized Payment Amount | 425.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 361 |
| Number Of Medicare Beneficiaries With Medical Services | 52 |
| Total Medical Submitted Charge Amount | 33986 |
| Total Medical Medicare Allowed Amount | 13718.68 |
| Total Medical Medicare Payment Amount | 9731.91 |
| Total Medical Medicare Standardized Payment Amount | 9956.06 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | 11 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0221 |