| National Provider Identifier [NPI]: | 1629050604 |
| Last Name Of The Provider | DICKINSON |
| First Name Of The Provider | MINDY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 715 HARMONY STREET |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | COUNCIL BLUFFS |
| Zip Code Of The Provider | 51503 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1264 |
| Number Of Medicare Beneficiaries | 894 |
| Total Submitted Charge Amount | 232673 |
| Total Medicare Allowed Amount | 120062.25 |
| Total Medicare Payment Amount | 75619.19 |
| Total Medicare Standardized Payment Amount | 83565.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 1264 |
| Number Of Medicare Beneficiaries With Medical Services | 894 |
| Total Medical Submitted Charge Amount | 232673 |
| Total Medical Medicare Allowed Amount | 120062.25 |
| Total Medical Medicare Payment Amount | 75619.19 |
| Total Medical Medicare Standardized Payment Amount | 83565.86 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 134 |
| Number Of Beneficiaries Age 65 to 74 | 398 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 105 |
| Number Of Female Beneficiaries | 535 |
| Number Of Male Beneficiaries | 359 |
| Number Of Non Hispanic White Beneficiaries | 855 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 738 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 156 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9866 |