| National Provider Identifier [NPI]: | 1912147075 |
| Last Name Of The Provider | FURDA-RAINE |
| First Name Of The Provider | LAURA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3800 PARK NICOLLET BLVD PARK NICOLLET CLINIC |
| 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 | 43 |
| Number Of Services | 676 |
| Number Of Medicare Beneficiaries | 155 |
| Total Submitted Charge Amount | 114130.75 |
| Total Medicare Allowed Amount | 40668.1 |
| Total Medicare Payment Amount | 30606.37 |
| Total Medicare Standardized Payment Amount | 30834.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 8109 |
| Total Drug Medicare AllowedAmount | 3201.05 |
| Total Drug Medicare PaymentAmount | 2499.43 |
| Total Drug Medicare Standardized Payment Amount | 2499.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 661 |
| Number Of Medicare Beneficiaries With Medical Services | 155 |
| Total Medical Submitted Charge Amount | 106021.75 |
| Total Medical Medicare Allowed Amount | 37467.05 |
| Total Medical Medicare Payment Amount | 28106.94 |
| Total Medical Medicare Standardized Payment Amount | 28334.67 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 94 |
| Number Of Male Beneficiaries | 61 |
| Number Of Non Hispanic White Beneficiaries | 142 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0113 |