National Provider Identifier [NPI]: |
1316991797 |
Last Name Of The Provider |
OLSON |
First Name Of The Provider |
CYNTHIA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3800 PARK NICOLLET BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
ST LOUIS PARK |
Zip Code Of The Provider |
55416 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
51 |
Number Of Services |
782 |
Number Of Medicare Beneficiaries |
174 |
Total Submitted Charge Amount |
112210.75 |
Total Medicare Allowed Amount |
40767.17 |
Total Medicare Payment Amount |
29764.75 |
Total Medicare Standardized Payment Amount |
29881.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
44 |
Number Of Medicare Beneficiaries With Drug Services |
21 |
Total Drug Submitted ChargeAmount |
13825 |
Total Drug Medicare AllowedAmount |
5504.34 |
Total Drug Medicare PaymentAmount |
4166.84 |
Total Drug Medicare Standardized Payment Amount |
4166.84 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
47 |
Number Of Medical Services |
738 |
Number Of Medicare Beneficiaries With Medical Services |
174 |
Total Medical Submitted Charge Amount |
98385.75 |
Total Medical Medicare Allowed Amount |
35262.83 |
Total Medical Medicare Payment Amount |
25597.91 |
Total Medical Medicare Standardized Payment Amount |
25714.46 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
62 |
Number Of Beneficiaries Age 75 to 84 |
53 |
Number Of Beneficiaries Age Greater 84 |
30 |
Number Of Female Beneficiaries |
100 |
Number Of Male Beneficiaries |
74 |
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 |
144 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
30 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
|
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
6 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
32 |
Percent Of With Hypertension |
45 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9827 |