National Provider Identifier [NPI]: |
1407817034 |
Last Name Of The Provider |
SIY |
First Name Of The Provider |
ROSALIE |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7500 FRANCE AVE S |
Street Address 2 Of The Provider |
|
City Of The Provider |
EDINA |
Zip Code Of The Provider |
554353400 |
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 |
52 |
Number Of Services |
2136 |
Number Of Medicare Beneficiaries |
223 |
Total Submitted Charge Amount |
186886 |
Total Medicare Allowed Amount |
81036.6 |
Total Medicare Payment Amount |
62717.15 |
Total Medicare Standardized Payment Amount |
63651.1 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
171 |
Number Of Medicare Beneficiaries With Drug Services |
93 |
Total Drug Submitted ChargeAmount |
10154 |
Total Drug Medicare AllowedAmount |
4625.97 |
Total Drug Medicare PaymentAmount |
4360.34 |
Total Drug Medicare Standardized Payment Amount |
4360.34 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
42 |
Number Of Medical Services |
1965 |
Number Of Medicare Beneficiaries With Medical Services |
223 |
Total Medical Submitted Charge Amount |
176732 |
Total Medical Medicare Allowed Amount |
76410.63 |
Total Medical Medicare Payment Amount |
58356.81 |
Total Medical Medicare Standardized Payment Amount |
59290.76 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
21 |
Number Of Beneficiaries Age 65 to 74 |
75 |
Number Of Beneficiaries Age 75 to 84 |
84 |
Number Of Beneficiaries Age Greater 84 |
43 |
Number Of Female Beneficiaries |
180 |
Number Of Male Beneficiaries |
43 |
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 |
204 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
5 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
20 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9545 |