| National Provider Identifier [NPI]: | 1982676615 |
| Last Name Of The Provider | BOESE |
| First Name Of The Provider | BRIDEY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | RN CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 520 SOUTH SIBLEY AVENUE |
| Street Address 2 Of The Provider | AFFILIATED COMMUNITY MEDICAL CENTERS |
| City Of The Provider | LITCHFIELD |
| Zip Code Of The Provider | 55355 |
| 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 | 109 |
| Number Of Services | 705 |
| Number Of Medicare Beneficiaries | 108 |
| Total Submitted Charge Amount | 58834.31 |
| Total Medicare Allowed Amount | 17910.71 |
| Total Medicare Payment Amount | 13839.81 |
| Total Medicare Standardized Payment Amount | 16077.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 726.21 |
| Total Drug Medicare AllowedAmount | 462.44 |
| Total Drug Medicare PaymentAmount | 429.86 |
| Total Drug Medicare Standardized Payment Amount | 429.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 654 |
| Number Of Medicare Beneficiaries With Medical Services | 108 |
| Total Medical Submitted Charge Amount | 58108.1 |
| Total Medical Medicare Allowed Amount | 17448.27 |
| Total Medical Medicare Payment Amount | 13409.95 |
| Total Medical Medicare Standardized Payment Amount | 15647.91 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 23 |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 39 |
| 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 | 62 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| 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 | 10 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1393 |