| National Provider Identifier [NPI]: | 1578859518 |
| Last Name Of The Provider | KOERITZ |
| First Name Of The Provider | LYDIA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2001 BLAISDELL AVE S |
| Street Address 2 Of The Provider | PARK NICOLLET CLINIC |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 55404 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 605 |
| Number Of Medicare Beneficiaries | 129 |
| Total Submitted Charge Amount | 46415.29 |
| Total Medicare Allowed Amount | 20798.56 |
| Total Medicare Payment Amount | 14725.98 |
| Total Medicare Standardized Payment Amount | 17478.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 1855.75 |
| Total Drug Medicare AllowedAmount | 1295.77 |
| Total Drug Medicare PaymentAmount | 1269.41 |
| Total Drug Medicare Standardized Payment Amount | 1269.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 569 |
| Number Of Medicare Beneficiaries With Medical Services | 129 |
| Total Medical Submitted Charge Amount | 44559.54 |
| Total Medical Medicare Allowed Amount | 19502.79 |
| Total Medical Medicare Payment Amount | 13456.57 |
| Total Medical Medicare Standardized Payment Amount | 16208.89 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 76 |
| Number Of Black or African American Beneficiaries | 42 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 24 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 9 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0773 |