| National Provider Identifier [NPI]: | 1538303938 |
| Last Name Of The Provider | RICKBEIL |
| First Name Of The Provider | TIFFANY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 SIXTH AVE N |
| Street Address 2 Of The Provider | CENTRA CARE CLINIC |
| City Of The Provider | ST CLOUD |
| Zip Code Of The Provider | 563032735 |
| 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 | 69 |
| Number Of Services | 1655 |
| Number Of Medicare Beneficiaries | 339 |
| Total Submitted Charge Amount | 249721.25 |
| Total Medicare Allowed Amount | 104002.22 |
| Total Medicare Payment Amount | 81021.64 |
| Total Medicare Standardized Payment Amount | 82593.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 2120.5 |
| Total Drug Medicare AllowedAmount | 1420.85 |
| Total Drug Medicare PaymentAmount | 1382.61 |
| Total Drug Medicare Standardized Payment Amount | 1382.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 1602 |
| Number Of Medicare Beneficiaries With Medical Services | 339 |
| Total Medical Submitted Charge Amount | 247600.75 |
| Total Medical Medicare Allowed Amount | 102581.37 |
| Total Medical Medicare Payment Amount | 79639.03 |
| Total Medical Medicare Standardized Payment Amount | 81211 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 85 |
| Number Of Beneficiaries Age 75 to 84 | 96 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 211 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | 322 |
| 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 | 243 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8272 |