| National Provider Identifier [NPI]: | 1487639159 |
| Last Name Of The Provider | RASMUSSEN |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14000 FAIRVIEW DR |
| Street Address 2 Of The Provider | PARK NICOLLET CLINIC BURNSVILLE |
| City Of The Provider | BURNSVILLE |
| Zip Code Of The Provider | 55337 |
| 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 | 35 |
| Number Of Services | 202 |
| Number Of Medicare Beneficiaries | 76 |
| Total Submitted Charge Amount | 17930.44 |
| Total Medicare Allowed Amount | 7654.28 |
| Total Medicare Payment Amount | 5310.38 |
| Total Medicare Standardized Payment Amount | 5436.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 59 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 84 |
| Total Drug Medicare AllowedAmount | 23.94 |
| Total Drug Medicare PaymentAmount | 18.79 |
| Total Drug Medicare Standardized Payment Amount | 18.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 143 |
| Number Of Medicare Beneficiaries With Medical Services | 76 |
| Total Medical Submitted Charge Amount | 17846.44 |
| Total Medical Medicare Allowed Amount | 7630.34 |
| Total Medical Medicare Payment Amount | 5291.59 |
| Total Medical Medicare Standardized Payment Amount | 5418.2 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 22 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 23 |
| Number Of Non Hispanic White Beneficiaries | 63 |
| 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 | 53 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0741 |