| National Provider Identifier [NPI]: | 1134377989 |
| Last Name Of The Provider | ENSIGN |
| First Name Of The Provider | MELISSA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 251 COUNTY ROAD 120 |
| Street Address 2 Of The Provider | SAINT CLOUD MEDICAL GROUP |
| City Of The Provider | SAINT CLOUD |
| Zip Code Of The Provider | 563034872 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 731 |
| Number Of Medicare Beneficiaries | 93 |
| Total Submitted Charge Amount | 56467.4 |
| Total Medicare Allowed Amount | 27385.3 |
| Total Medicare Payment Amount | 20839.17 |
| Total Medicare Standardized Payment Amount | 21340.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1333.8 |
| Total Drug Medicare AllowedAmount | 953.3 |
| Total Drug Medicare PaymentAmount | 922.3 |
| Total Drug Medicare Standardized Payment Amount | 922.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 705 |
| Number Of Medicare Beneficiaries With Medical Services | 93 |
| Total Medical Submitted Charge Amount | 55133.6 |
| Total Medical Medicare Allowed Amount | 26432 |
| Total Medical Medicare Payment Amount | 19916.87 |
| Total Medical Medicare Standardized Payment Amount | 20417.79 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 22 |
| Number Of Beneficiaries Age 75 to 84 | 15 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 71 |
| Number Of Male Beneficiaries | 22 |
| 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 | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| 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 | 15 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1791 |