| National Provider Identifier [NPI]: | 1699707315 |
| Last Name Of The Provider | GJERDINGEN |
| First Name Of The Provider | DWENDA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | UFP BETHESDA CLINIC |
| Street Address 2 Of The Provider | 580 RICE STREET |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 55103 |
| 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 | 43 |
| Number Of Services | 498 |
| Number Of Medicare Beneficiaries | 74 |
| Total Submitted Charge Amount | 52287 |
| Total Medicare Allowed Amount | 19608.1 |
| Total Medicare Payment Amount | 15250.79 |
| Total Medicare Standardized Payment Amount | 15647.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 839 |
| Total Drug Medicare AllowedAmount | 522.71 |
| Total Drug Medicare PaymentAmount | 511.89 |
| Total Drug Medicare Standardized Payment Amount | 511.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 482 |
| Number Of Medicare Beneficiaries With Medical Services | 73 |
| Total Medical Submitted Charge Amount | 51448 |
| Total Medical Medicare Allowed Amount | 19085.39 |
| Total Medical Medicare Payment Amount | 14738.9 |
| Total Medical Medicare Standardized Payment Amount | 15135.64 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 45 |
| Number Of Male Beneficiaries | 29 |
| Number Of Non Hispanic White Beneficiaries | 42 |
| Number Of Black or African American Beneficiaries | 20 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 19 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.6937 |