| National Provider Identifier [NPI]: | 1912961228 |
| Last Name Of The Provider | STAPLETON |
| First Name Of The Provider | MOLLIE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 927 TRETTEL LANE |
| Street Address 2 Of The Provider | FOND DU LAC HUMAN SERVICES DIVISION |
| City Of The Provider | CLOQUET |
| Zip Code Of The Provider | 55720 |
| 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 | 40 |
| Number Of Services | 528 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 63865 |
| Total Medicare Allowed Amount | 21747.1 |
| Total Medicare Payment Amount | 16182.34 |
| Total Medicare Standardized Payment Amount | 16487.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1145 |
| Total Drug Medicare AllowedAmount | 358.32 |
| Total Drug Medicare PaymentAmount | 340.52 |
| Total Drug Medicare Standardized Payment Amount | 340.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 484 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 62720 |
| Total Medical Medicare Allowed Amount | 21388.78 |
| Total Medical Medicare Payment Amount | 15841.82 |
| Total Medical Medicare Standardized Payment Amount | 16146.93 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 48 |
| Number Of Male Beneficiaries | 44 |
| 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 | 46 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4862 |