| National Provider Identifier [NPI]: | 1265416572 |
| Last Name Of The Provider | PERMUTH |
| First Name Of The Provider | SUZANNE |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1885 PLAZA DR |
| Street Address 2 Of The Provider | PARK NICOLLET CLINIC EAGAN |
| City Of The Provider | EAGAN |
| Zip Code Of The Provider | 551222612 |
| 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 | 38 |
| Number Of Services | 971 |
| Number Of Medicare Beneficiaries | 85 |
| Total Submitted Charge Amount | 56691.77 |
| Total Medicare Allowed Amount | 23582.2 |
| Total Medicare Payment Amount | 18108.29 |
| Total Medicare Standardized Payment Amount | 18915.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 48 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 6073 |
| Total Drug Medicare AllowedAmount | 3547.49 |
| Total Drug Medicare PaymentAmount | 3382.94 |
| Total Drug Medicare Standardized Payment Amount | 3382.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 923 |
| Number Of Medicare Beneficiaries With Medical Services | 85 |
| Total Medical Submitted Charge Amount | 50618.77 |
| Total Medical Medicare Allowed Amount | 20034.71 |
| Total Medical Medicare Payment Amount | 14725.35 |
| Total Medical Medicare Standardized Payment Amount | 15532.76 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 43 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 65 |
| Number Of Male Beneficiaries | 20 |
| 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 | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8651 |