| National Provider Identifier [NPI]: | 1295715308 |
| Last Name Of The Provider | DETTMER |
| First Name Of The Provider | PAULINE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 920 SECOND AVENUE, SOUTH |
| Street Address 2 Of The Provider | SUITE#400 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 55402 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 574 |
| Number Of Medicare Beneficiaries | 290 |
| Total Submitted Charge Amount | 18031.64 |
| Total Medicare Allowed Amount | 16443.4 |
| Total Medicare Payment Amount | 14598.36 |
| Total Medicare Standardized Payment Amount | 17990.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 255 |
| Number Of Medicare Beneficiaries With Drug Services | 247 |
| Total Drug Submitted ChargeAmount | 10244.64 |
| Total Drug Medicare AllowedAmount | 8939.86 |
| Total Drug Medicare PaymentAmount | 8558.51 |
| Total Drug Medicare Standardized Payment Amount | 8558.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 319 |
| Number Of Medicare Beneficiaries With Medical Services | 288 |
| Total Medical Submitted Charge Amount | 7787 |
| Total Medical Medicare Allowed Amount | 7503.54 |
| Total Medical Medicare Payment Amount | 6039.85 |
| Total Medical Medicare Standardized Payment Amount | 9432.06 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 163 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 190 |
| Number Of Male Beneficiaries | 100 |
| 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 | 279 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7459 |