| National Provider Identifier [NPI]: | 1770765141 |
| Last Name Of The Provider | NAVARRETE |
| First Name Of The Provider | GUSTAVO |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1415 ST FRANCIS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHAKOPEE |
| Zip Code Of The Provider | 55379 |
| 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 | 58 |
| Number Of Services | 1463 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 100257.75 |
| Total Medicare Allowed Amount | 43380.02 |
| Total Medicare Payment Amount | 31276.59 |
| Total Medicare Standardized Payment Amount | 32764.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 597 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 10589 |
| Total Drug Medicare AllowedAmount | 4554.62 |
| Total Drug Medicare PaymentAmount | 3645.85 |
| Total Drug Medicare Standardized Payment Amount | 3645.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 866 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 89668.75 |
| Total Medical Medicare Allowed Amount | 38825.4 |
| Total Medical Medicare Payment Amount | 27630.74 |
| Total Medical Medicare Standardized Payment Amount | 29118.22 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 93 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3431 |