| National Provider Identifier [NPI]: | 1730309147 |
| Last Name Of The Provider | GUSTAFSON |
| First Name Of The Provider | BELINDA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11000 LAKE CITY WAY NE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SEATTLE |
| Zip Code Of The Provider | 981256748 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 3634 |
| Number Of Medicare Beneficiaries | 320 |
| Total Submitted Charge Amount | 408557.5 |
| Total Medicare Allowed Amount | 305360.02 |
| Total Medicare Payment Amount | 229948.58 |
| Total Medicare Standardized Payment Amount | 226600.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 3634 |
| Number Of Medicare Beneficiaries With Medical Services | 320 |
| Total Medical Submitted Charge Amount | 408557.5 |
| Total Medical Medicare Allowed Amount | 305360.02 |
| Total Medical Medicare Payment Amount | 229948.58 |
| Total Medical Medicare Standardized Payment Amount | 226600.74 |
| Average Age Of Beneficiaries | 51 |
| Number Of Beneficiaries Age Less65 | 262 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 174 |
| Number Of Male Beneficiaries | 146 |
| Number Of Non Hispanic White Beneficiaries | 255 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 30 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 290 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 20 |
| Percent Of With Hypertension | 28 |
| Percent Of With Ischemic Heart Disease | 8 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 12 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 42 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0089 |