| National Provider Identifier [NPI]: | 1205806254 |
| Last Name Of The Provider | WILLIAMS |
| First Name Of The Provider | RAE |
| 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 | 2500 COMO AVENUE |
| Street Address 2 Of The Provider | MAIL STOP 31100A |
| City Of The Provider | ST PAUL |
| Zip Code Of The Provider | 551081460 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 161 |
| Number Of Medicare Beneficiaries | 28 |
| Total Submitted Charge Amount | 16923 |
| Total Medicare Allowed Amount | 6148.75 |
| Total Medicare Payment Amount | 4240.41 |
| Total Medicare Standardized Payment Amount | 4719.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 322 |
| Total Drug Medicare AllowedAmount | 264.57 |
| Total Drug Medicare PaymentAmount | 101.39 |
| Total Drug Medicare Standardized Payment Amount | 101.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 149 |
| Number Of Medicare Beneficiaries With Medical Services | 28 |
| Total Medical Submitted Charge Amount | 16601 |
| Total Medical Medicare Allowed Amount | 5884.18 |
| Total Medical Medicare Payment Amount | 4139.02 |
| Total Medical Medicare Standardized Payment Amount | 4618.21 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 39 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0106 |