| National Provider Identifier [NPI]: | 1205932902 |
| Last Name Of The Provider | BULLOCK |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | RN, CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2845 HAMLINE AVE NORTH |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROSEVILLE |
| Zip Code Of The Provider | 55113 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 230 |
| Number Of Medicare Beneficiaries | 70 |
| Total Submitted Charge Amount | 32031.69 |
| Total Medicare Allowed Amount | 24818.56 |
| Total Medicare Payment Amount | 18900.48 |
| Total Medicare Standardized Payment Amount | 22780.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 230 |
| Number Of Medicare Beneficiaries With Medical Services | 70 |
| Total Medical Submitted Charge Amount | 32031.69 |
| Total Medical Medicare Allowed Amount | 24818.56 |
| Total Medical Medicare Payment Amount | 18900.48 |
| Total Medical Medicare Standardized Payment Amount | 22780.74 |
| Average Age Of Beneficiaries | 87 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 45 |
| Number Of Male Beneficiaries | 25 |
| Number Of Non Hispanic White Beneficiaries | 70 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 56 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 34 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 51 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 23 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.2651 |