| National Provider Identifier [NPI]: | 1346212495 |
| Last Name Of The Provider | SIMON |
| First Name Of The Provider | GWENDOLYN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8450 SEASONS PKWY |
| Street Address 2 Of The Provider | MAIL STOP 32900A |
| City Of The Provider | WOODBURY |
| Zip Code Of The Provider | 551254402 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 315 |
| Number Of Medicare Beneficiaries | 48 |
| Total Submitted Charge Amount | 36375 |
| Total Medicare Allowed Amount | 13689.13 |
| Total Medicare Payment Amount | 9990.36 |
| Total Medicare Standardized Payment Amount | 10531.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1951 |
| Total Drug Medicare AllowedAmount | 1062.78 |
| Total Drug Medicare PaymentAmount | 754.01 |
| Total Drug Medicare Standardized Payment Amount | 754.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 247 |
| Number Of Medicare Beneficiaries With Medical Services | 48 |
| Total Medical Submitted Charge Amount | 34424 |
| Total Medical Medicare Allowed Amount | 12626.35 |
| Total Medical Medicare Payment Amount | 9236.35 |
| Total Medical Medicare Standardized Payment Amount | 9777.01 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 35 |
| Number Of Male Beneficiaries | 13 |
| Number Of Non Hispanic White Beneficiaries | 34 |
| 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 | 21 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| 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 | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5219 |