| National Provider Identifier [NPI]: | 1336309384 |
| Last Name Of The Provider | TSUBAKI |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3800 LEXINGTON AVE N |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHOREVIEW |
| Zip Code Of The Provider | 551262916 |
| 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 | 15 |
| Number Of Services | 301 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 9266.1 |
| Total Medicare Allowed Amount | 8108.47 |
| Total Medicare Payment Amount | 6329.86 |
| Total Medicare Standardized Payment Amount | 8589.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 117 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 3722.1 |
| Total Drug Medicare AllowedAmount | 3074.15 |
| Total Drug Medicare PaymentAmount | 2703.71 |
| Total Drug Medicare Standardized Payment Amount | 2703.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 184 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 5544 |
| Total Medical Medicare Allowed Amount | 5034.32 |
| Total Medical Medicare Payment Amount | 3626.15 |
| Total Medical Medicare Standardized Payment Amount | 5885.94 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| 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 | 13 |
| Percent Of With Diabetes | 9 |
| Percent Of With Hyperlipidemia | 21 |
| Percent Of With Hypertension | 32 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 15 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6048 |