| National Provider Identifier [NPI]: | 1922096379 |
| Last Name Of The Provider | MITCHELL |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6025 LAKE RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | WOODBURY |
| Zip Code Of The Provider | 551251712 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 1810 |
| Number Of Medicare Beneficiaries | 196 |
| Total Submitted Charge Amount | 183730 |
| Total Medicare Allowed Amount | 68902.48 |
| Total Medicare Payment Amount | 54037.03 |
| Total Medicare Standardized Payment Amount | 58736.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 477 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 5247 |
| Total Drug Medicare AllowedAmount | 2367.47 |
| Total Drug Medicare PaymentAmount | 1837.8 |
| Total Drug Medicare Standardized Payment Amount | 1837.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1333 |
| Number Of Medicare Beneficiaries With Medical Services | 196 |
| Total Medical Submitted Charge Amount | 178483 |
| Total Medical Medicare Allowed Amount | 66535.01 |
| Total Medical Medicare Payment Amount | 52199.23 |
| Total Medical Medicare Standardized Payment Amount | 56898.55 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 110 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 161 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 162 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 50 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0931 |