| National Provider Identifier [NPI]: | 1134235344 |
| Last Name Of The Provider | IDZIOREK |
| First Name Of The Provider | PAMELA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | RNNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4891 MILLER TRUNK HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | HERMANTOWN |
| Zip Code Of The Provider | 558111512 |
| 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 | 35 |
| Number Of Services | 263 |
| Number Of Medicare Beneficiaries | 56 |
| Total Submitted Charge Amount | 25953.76 |
| Total Medicare Allowed Amount | 9331.19 |
| Total Medicare Payment Amount | 7258.09 |
| Total Medicare Standardized Payment Amount | 8346.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 65 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1207.44 |
| Total Drug Medicare AllowedAmount | 211.99 |
| Total Drug Medicare PaymentAmount | 202.58 |
| Total Drug Medicare Standardized Payment Amount | 202.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 198 |
| Number Of Medicare Beneficiaries With Medical Services | 56 |
| Total Medical Submitted Charge Amount | 24746.32 |
| Total Medical Medicare Allowed Amount | 9119.2 |
| Total Medical Medicare Payment Amount | 7055.51 |
| Total Medical Medicare Standardized Payment Amount | 8143.95 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 13 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 29 |
| Number Of Male Beneficiaries | 27 |
| 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 | 28 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 25 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 52 |
| Percent Of With Depression | 63 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 21 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7062 |