| National Provider Identifier [NPI]: | 1922350172 |
| Last Name Of The Provider | TRACZYK |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2090 WOODWINDS DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBURY |
| Zip Code Of The Provider | 551252522 |
| 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 | 52 |
| Number Of Services | 677 |
| Number Of Medicare Beneficiaries | 172 |
| Total Submitted Charge Amount | 260207.5 |
| Total Medicare Allowed Amount | 31053.67 |
| Total Medicare Payment Amount | 23910.22 |
| Total Medicare Standardized Payment Amount | 27058.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 295 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 5316 |
| Total Drug Medicare AllowedAmount | 3281.16 |
| Total Drug Medicare PaymentAmount | 2568.08 |
| Total Drug Medicare Standardized Payment Amount | 2568.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 382 |
| Number Of Medicare Beneficiaries With Medical Services | 172 |
| Total Medical Submitted Charge Amount | 254891.5 |
| Total Medical Medicare Allowed Amount | 27772.51 |
| Total Medical Medicare Payment Amount | 21342.14 |
| Total Medical Medicare Standardized Payment Amount | 24490.36 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 109 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 161 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 138 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0411 |