| National Provider Identifier [NPI]: | 1104086065 |
| Last Name Of The Provider | KOFSTAD |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MSN-FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1233 N 30TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BILLINGS |
| Zip Code Of The Provider | 591010127 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 153 |
| Number Of Medicare Beneficiaries | 122 |
| Total Submitted Charge Amount | 30901.5 |
| Total Medicare Allowed Amount | 13310.49 |
| Total Medicare Payment Amount | 10666.21 |
| Total Medicare Standardized Payment Amount | 12425.83 |
| 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 | 8 |
| Number Of Medical Services | 153 |
| Number Of Medicare Beneficiaries With Medical Services | 122 |
| Total Medical Submitted Charge Amount | 30901.5 |
| Total Medical Medicare Allowed Amount | 13310.49 |
| Total Medical Medicare Payment Amount | 10666.21 |
| Total Medical Medicare Standardized Payment Amount | 12425.83 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 63 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 107 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.5059 |