| National Provider Identifier [NPI]: | 1699843581 |
| Last Name Of The Provider | FISKE |
| First Name Of The Provider | RENNYE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6405 FRANCE AVE S |
| Street Address 2 Of The Provider | SUITE W440 |
| City Of The Provider | EDINA |
| Zip Code Of The Provider | 554352163 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 404 |
| Number Of Medicare Beneficiaries | 140 |
| Total Submitted Charge Amount | 64742.8 |
| Total Medicare Allowed Amount | 13019.31 |
| Total Medicare Payment Amount | 9343.7 |
| Total Medicare Standardized Payment Amount | 11636.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 830.8 |
| Total Drug Medicare AllowedAmount | 691.48 |
| Total Drug Medicare PaymentAmount | 633.1 |
| Total Drug Medicare Standardized Payment Amount | 633.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 382 |
| Number Of Medicare Beneficiaries With Medical Services | 140 |
| Total Medical Submitted Charge Amount | 63912 |
| Total Medical Medicare Allowed Amount | 12327.83 |
| Total Medical Medicare Payment Amount | 8710.6 |
| Total Medical Medicare Standardized Payment Amount | 11003.29 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 30 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 78 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 120 |
| 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 | 72 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 3.0591 |