| National Provider Identifier [NPI]: | 1659631372 |
| Last Name Of The Provider | BROWN |
| First Name Of The Provider | DERRICK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4855 W ARROWHEAD RD |
| Street Address 2 Of The Provider | ESSENTIA HEALTH HERMANTOWN CLINIC |
| City Of The Provider | HERMANTOWN |
| Zip Code Of The Provider | 558113936 |
| 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 | 54 |
| Number Of Services | 302 |
| Number Of Medicare Beneficiaries | 56 |
| Total Submitted Charge Amount | 38851 |
| Total Medicare Allowed Amount | 17853.34 |
| Total Medicare Payment Amount | 13425 |
| Total Medicare Standardized Payment Amount | 13701.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 458 |
| Total Drug Medicare AllowedAmount | 263.81 |
| Total Drug Medicare PaymentAmount | 256.59 |
| Total Drug Medicare Standardized Payment Amount | 256.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 282 |
| Number Of Medicare Beneficiaries With Medical Services | 56 |
| Total Medical Submitted Charge Amount | 38393 |
| Total Medical Medicare Allowed Amount | 17589.53 |
| Total Medical Medicare Payment Amount | 13168.41 |
| Total Medical Medicare Standardized Payment Amount | 13445.33 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 24 |
| Number Of Male Beneficiaries | 32 |
| Number Of Non Hispanic White Beneficiaries | 45 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 63 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 25 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1899 |