| National Provider Identifier [NPI]: | 1124058110 |
| Last Name Of The Provider | EGGINK |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1020 BANDANA BLVD W |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551085107 |
| 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 | 36 |
| Number Of Services | 370 |
| Number Of Medicare Beneficiaries | 67 |
| Total Submitted Charge Amount | 41662 |
| Total Medicare Allowed Amount | 15487.18 |
| Total Medicare Payment Amount | 11764.16 |
| Total Medicare Standardized Payment Amount | 13767.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 736 |
| Total Drug Medicare AllowedAmount | 443.96 |
| Total Drug Medicare PaymentAmount | 435.07 |
| Total Drug Medicare Standardized Payment Amount | 435.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 357 |
| Number Of Medicare Beneficiaries With Medical Services | 67 |
| Total Medical Submitted Charge Amount | 40926 |
| Total Medical Medicare Allowed Amount | 15043.22 |
| Total Medical Medicare Payment Amount | 11329.09 |
| Total Medical Medicare Standardized Payment Amount | 13332.62 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 51 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | 48 |
| 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 | 36 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9471 |