| National Provider Identifier [NPI]: | 1508884917 |
| Last Name Of The Provider | MYROM |
| First Name Of The Provider | SHELLY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 924 1ST ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FARIBAULT |
| Zip Code Of The Provider | 550215441 |
| 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 | 39 |
| Number Of Services | 325 |
| Number Of Medicare Beneficiaries | 140 |
| Total Submitted Charge Amount | 59181.4 |
| Total Medicare Allowed Amount | 20592.17 |
| Total Medicare Payment Amount | 14384.33 |
| Total Medicare Standardized Payment Amount | 16953.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1162.4 |
| Total Drug Medicare AllowedAmount | 761.68 |
| Total Drug Medicare PaymentAmount | 741.29 |
| Total Drug Medicare Standardized Payment Amount | 741.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 299 |
| Number Of Medicare Beneficiaries With Medical Services | 140 |
| Total Medical Submitted Charge Amount | 58019 |
| Total Medical Medicare Allowed Amount | 19830.49 |
| Total Medical Medicare Payment Amount | 13643.04 |
| Total Medical Medicare Standardized Payment Amount | 16212.11 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 41 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 47 |
| 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 | 84 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.003 |