| National Provider Identifier [NPI]: | 1427026780 |
| Last Name Of The Provider | GUNNARSON |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 407 E 3RD ST |
| Street Address 2 Of The Provider | ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558051950 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 263 |
| Number Of Medicare Beneficiaries | 242 |
| Total Submitted Charge Amount | 105267 |
| Total Medicare Allowed Amount | 30871.18 |
| Total Medicare Payment Amount | 23381.95 |
| Total Medicare Standardized Payment Amount | 24389.92 |
| 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 | 15 |
| Number Of Medical Services | 263 |
| Number Of Medicare Beneficiaries With Medical Services | 242 |
| Total Medical Submitted Charge Amount | 105267 |
| Total Medical Medicare Allowed Amount | 30871.18 |
| Total Medical Medicare Payment Amount | 23381.95 |
| Total Medical Medicare Standardized Payment Amount | 24389.92 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 106 |
| Number Of Beneficiaries Age 65 to 74 | 48 |
| Number Of Beneficiaries Age 75 to 84 | 46 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 123 |
| Number Of Non Hispanic White Beneficiaries | 222 |
| 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 | 123 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 26 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.9432 |