| National Provider Identifier [NPI]: | 1033196431 |
| Last Name Of The Provider | BERAN |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15111 TWELVE OAKS CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MINNETONKA |
| Zip Code Of The Provider | 553055201 |
| 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 | 42 |
| Number Of Services | 1563 |
| Number Of Medicare Beneficiaries | 151 |
| Total Submitted Charge Amount | 113092.1 |
| Total Medicare Allowed Amount | 50383.71 |
| Total Medicare Payment Amount | 37181.06 |
| Total Medicare Standardized Payment Amount | 38215.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 239 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 4384 |
| Total Drug Medicare AllowedAmount | 2949.99 |
| Total Drug Medicare PaymentAmount | 2847.32 |
| Total Drug Medicare Standardized Payment Amount | 2847.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 1324 |
| Number Of Medicare Beneficiaries With Medical Services | 151 |
| Total Medical Submitted Charge Amount | 108708.1 |
| Total Medical Medicare Allowed Amount | 47433.72 |
| Total Medical Medicare Payment Amount | 34333.74 |
| Total Medical Medicare Standardized Payment Amount | 35367.95 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 58 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 32 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0517 |