| National Provider Identifier [NPI]: | 1346435740 |
| Last Name Of The Provider | SHATSKIKH |
| First Name Of The Provider | KONSTANTIN |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 810 COUNTY ROAD 42 W |
| Street Address 2 Of The Provider | |
| City Of The Provider | BURNSVILLE |
| Zip Code Of The Provider | 55337 |
| 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 | 33 |
| Number Of Services | 348 |
| Number Of Medicare Beneficiaries | 226 |
| Total Submitted Charge Amount | 40093.05 |
| Total Medicare Allowed Amount | 15557.37 |
| Total Medicare Payment Amount | 10280.12 |
| Total Medicare Standardized Payment Amount | 12934.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1528.05 |
| Total Drug Medicare AllowedAmount | 552.8 |
| Total Drug Medicare PaymentAmount | 499.47 |
| Total Drug Medicare Standardized Payment Amount | 499.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 272 |
| Number Of Medicare Beneficiaries With Medical Services | 225 |
| Total Medical Submitted Charge Amount | 38565 |
| Total Medical Medicare Allowed Amount | 15004.57 |
| Total Medical Medicare Payment Amount | 9780.65 |
| Total Medical Medicare Standardized Payment Amount | 12434.54 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 76 |
| 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 | 171 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0118 |