| National Provider Identifier [NPI]: | 1821252800 |
| Last Name Of The Provider | LOVOLD |
| First Name Of The Provider | AMANDA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1520 WHITNEY CT |
| Street Address 2 Of The Provider | CENTRACARE CLINIC-HEARTLAND FAMILY MEDICINE |
| City Of The Provider | ST CLOUD |
| Zip Code Of The Provider | 567031899 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 1034 |
| Number Of Medicare Beneficiaries | 81 |
| Total Submitted Charge Amount | 64768.25 |
| Total Medicare Allowed Amount | 27470.26 |
| Total Medicare Payment Amount | 21192.84 |
| Total Medicare Standardized Payment Amount | 21447.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 320 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 828.75 |
| Total Drug Medicare AllowedAmount | 569.21 |
| Total Drug Medicare PaymentAmount | 540.43 |
| Total Drug Medicare Standardized Payment Amount | 540.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 714 |
| Number Of Medicare Beneficiaries With Medical Services | 81 |
| Total Medical Submitted Charge Amount | 63939.5 |
| Total Medical Medicare Allowed Amount | 26901.05 |
| Total Medical Medicare Payment Amount | 20652.41 |
| Total Medical Medicare Standardized Payment Amount | 20907.11 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 17 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 65 |
| Number Of Male Beneficiaries | 16 |
| 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 | 38 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| 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 | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0887 |