| National Provider Identifier [NPI]: | 1285814319 |
| Last Name Of The Provider | NISAR |
| First Name Of The Provider | FATIMA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MBBS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11475 ROBINSON DRIVE NW - MAILSTOP 32600A |
| Street Address 2 Of The Provider | HEALTHPARTNERS COON RAPIDS CLINIC |
| City Of The Provider | COON RAPIDS |
| Zip Code Of The Provider | 554333746 |
| 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 | 50 |
| Number Of Services | 609 |
| Number Of Medicare Beneficiaries | 63 |
| Total Submitted Charge Amount | 41666 |
| Total Medicare Allowed Amount | 15156.9 |
| Total Medicare Payment Amount | 11040.55 |
| Total Medicare Standardized Payment Amount | 11180.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 337 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 759 |
| Total Drug Medicare AllowedAmount | 329.36 |
| Total Drug Medicare PaymentAmount | 274.63 |
| Total Drug Medicare Standardized Payment Amount | 274.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 272 |
| Number Of Medicare Beneficiaries With Medical Services | 63 |
| Total Medical Submitted Charge Amount | 40907 |
| Total Medical Medicare Allowed Amount | 14827.54 |
| Total Medical Medicare Payment Amount | 10765.92 |
| Total Medical Medicare Standardized Payment Amount | 10905.71 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 21 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 49 |
| Number Of Male Beneficiaries | 14 |
| Number Of Non Hispanic White Beneficiaries | 47 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 31 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| 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 | 35 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.936 |