| National Provider Identifier [NPI]: | 1487658415 |
| Last Name Of The Provider | EVANS |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2828 CHICAGO AVE SOUTH |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554071320 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 8384 |
| Number Of Medicare Beneficiaries | 199 |
| Total Submitted Charge Amount | 416536 |
| Total Medicare Allowed Amount | 213849.58 |
| Total Medicare Payment Amount | 156413.82 |
| Total Medicare Standardized Payment Amount | 158559.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 7852 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 280336 |
| Total Drug Medicare AllowedAmount | 161179.38 |
| Total Drug Medicare PaymentAmount | 120046.06 |
| Total Drug Medicare Standardized Payment Amount | 120046.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 532 |
| Number Of Medicare Beneficiaries With Medical Services | 199 |
| Total Medical Submitted Charge Amount | 136200 |
| Total Medical Medicare Allowed Amount | 52670.2 |
| Total Medical Medicare Payment Amount | 36367.76 |
| Total Medical Medicare Standardized Payment Amount | 38513.46 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 109 |
| Number Of Beneficiaries Age 65 to 74 | 48 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | 176 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 123 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 37 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2223 |