| National Provider Identifier [NPI]: | 1619904208 |
| Last Name Of The Provider | DESSIE |
| First Name Of The Provider | HELLINA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5502 W BROADWAY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CRYSTAL |
| Zip Code Of The Provider | 554283508 |
| 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 | 63 |
| Number Of Services | 360 |
| Number Of Medicare Beneficiaries | 94 |
| Total Submitted Charge Amount | 39023 |
| Total Medicare Allowed Amount | 16887.18 |
| Total Medicare Payment Amount | 12016.13 |
| Total Medicare Standardized Payment Amount | 12373.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 490 |
| Total Drug Medicare AllowedAmount | 406.65 |
| Total Drug Medicare PaymentAmount | 394.2 |
| Total Drug Medicare Standardized Payment Amount | 394.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 349 |
| Number Of Medicare Beneficiaries With Medical Services | 94 |
| Total Medical Submitted Charge Amount | 38533 |
| Total Medical Medicare Allowed Amount | 16480.53 |
| Total Medical Medicare Payment Amount | 11621.93 |
| Total Medical Medicare Standardized Payment Amount | 11978.88 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 19 |
| Number Of Beneficiaries Age 75 to 84 | 24 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 64 |
| Number Of Male Beneficiaries | 30 |
| Number Of Non Hispanic White Beneficiaries | 82 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 51 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2502 |