| National Provider Identifier [NPI]: | 1508208042 |
| Last Name Of The Provider | MIKOTA |
| First Name Of The Provider | SAMANTHA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DNP, ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 23019 HIGHWAY 149 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SIGOURNEY |
| Zip Code Of The Provider | 525918341 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 327 |
| Number Of Medicare Beneficiaries | 88 |
| Total Submitted Charge Amount | 28082.3 |
| Total Medicare Allowed Amount | 14055.83 |
| Total Medicare Payment Amount | 10137.33 |
| Total Medicare Standardized Payment Amount | 12923.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1271.45 |
| Total Drug Medicare AllowedAmount | 144.56 |
| Total Drug Medicare PaymentAmount | 132.99 |
| Total Drug Medicare Standardized Payment Amount | 132.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 264 |
| Number Of Medicare Beneficiaries With Medical Services | 88 |
| Total Medical Submitted Charge Amount | 26810.85 |
| Total Medical Medicare Allowed Amount | 13911.27 |
| Total Medical Medicare Payment Amount | 10004.34 |
| Total Medical Medicare Standardized Payment Amount | 12790.94 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 15 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 34 |
| 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 | 51 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2994 |