| National Provider Identifier [NPI]: | 1194790006 |
| Last Name Of The Provider | HESTDALEN |
| First Name Of The Provider | STACI |
| 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 | 1807 N HUTCHINSON RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOKANE VALLEY |
| Zip Code Of The Provider | 992122444 |
| 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 | 65 |
| Number Of Services | 3726 |
| Number Of Medicare Beneficiaries | 1023 |
| Total Submitted Charge Amount | 418132 |
| Total Medicare Allowed Amount | 205648.47 |
| Total Medicare Payment Amount | 143877.6 |
| Total Medicare Standardized Payment Amount | 145604.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 83 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 4442 |
| Total Drug Medicare AllowedAmount | 3774.38 |
| Total Drug Medicare PaymentAmount | 2782.53 |
| Total Drug Medicare Standardized Payment Amount | 2782.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 3643 |
| Number Of Medicare Beneficiaries With Medical Services | 1023 |
| Total Medical Submitted Charge Amount | 413690 |
| Total Medical Medicare Allowed Amount | 201874.09 |
| Total Medical Medicare Payment Amount | 141095.07 |
| Total Medical Medicare Standardized Payment Amount | 142821.6 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 518 |
| Number Of Beneficiaries Age 75 to 84 | 350 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 640 |
| Number Of Male Beneficiaries | 383 |
| Number Of Non Hispanic White Beneficiaries | 999 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 983 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8589 |