| National Provider Identifier [NPI]: | 1174747018 |
| Last Name Of The Provider | BAILEY |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 576 APOLLO DR - MAIL STOP 39603A |
| Street Address 2 Of The Provider | NORTH SUBURBAN FAMILY PHYSICIANS - LINO LAKES |
| City Of The Provider | LINO LAKES |
| Zip Code Of The Provider | 550143004 |
| 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 | 41 |
| Number Of Services | 266 |
| Number Of Medicare Beneficiaries | 49 |
| Total Submitted Charge Amount | 29402 |
| Total Medicare Allowed Amount | 10624.61 |
| Total Medicare Payment Amount | 7789.33 |
| Total Medicare Standardized Payment Amount | 7891.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 1051 |
| Total Drug Medicare AllowedAmount | 554.51 |
| Total Drug Medicare PaymentAmount | 543.44 |
| Total Drug Medicare Standardized Payment Amount | 543.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 248 |
| Number Of Medicare Beneficiaries With Medical Services | 49 |
| Total Medical Submitted Charge Amount | 28351 |
| Total Medical Medicare Allowed Amount | 10070.1 |
| Total Medical Medicare Payment Amount | 7245.89 |
| Total Medical Medicare Standardized Payment Amount | 7347.94 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 21 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 36 |
| Number Of Male Beneficiaries | 13 |
| 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 | 24 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0252 |