| National Provider Identifier [NPI]: | 1336187814 |
| Last Name Of The Provider | POLUKHIN |
| First Name Of The Provider | ELENA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD, PHD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3015 UTAH AVE S |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SAINT LOUIS PARK |
| Zip Code Of The Provider | 554263671 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 33777 |
| Number Of Medicare Beneficiaries | 372 |
| Total Submitted Charge Amount | 2523406 |
| Total Medicare Allowed Amount | 1147460.2 |
| Total Medicare Payment Amount | 881519.28 |
| Total Medicare Standardized Payment Amount | 861028.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 14119 |
| Number Of Medicare Beneficiaries With Drug Services | 327 |
| Total Drug Submitted ChargeAmount | 280380 |
| Total Drug Medicare AllowedAmount | 166281.1 |
| Total Drug Medicare PaymentAmount | 130293.85 |
| Total Drug Medicare Standardized Payment Amount | 130293.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 19658 |
| Number Of Medicare Beneficiaries With Medical Services | 372 |
| Total Medical Submitted Charge Amount | 2243026 |
| Total Medical Medicare Allowed Amount | 981179.1 |
| Total Medical Medicare Payment Amount | 751225.43 |
| Total Medical Medicare Standardized Payment Amount | 730734.67 |
| Average Age Of Beneficiaries | 53 |
| Number Of Beneficiaries Age Less65 | 334 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 207 |
| Number Of Male Beneficiaries | 165 |
| Number Of Non Hispanic White Beneficiaries | 131 |
| Number Of Black or African American Beneficiaries | 210 |
| 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 | 49 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 323 |
| Percent Of With Atrial Fibrillation | 3 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 54 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 24 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4907 |