| National Provider Identifier [NPI]: | 1093729873 |
| Last Name Of The Provider | NELSEN |
| First Name Of The Provider | MICHELE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14410 SE PETROVITSKY RD |
| Street Address 2 Of The Provider | STE 104 |
| City Of The Provider | RENTON |
| Zip Code Of The Provider | 980588900 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 549 |
| Number Of Medicare Beneficiaries | 151 |
| Total Submitted Charge Amount | 102868.05 |
| Total Medicare Allowed Amount | 42662.06 |
| Total Medicare Payment Amount | 30130 |
| Total Medicare Standardized Payment Amount | 28487.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1383.05 |
| Total Drug Medicare AllowedAmount | 1107.89 |
| Total Drug Medicare PaymentAmount | 1060.54 |
| Total Drug Medicare Standardized Payment Amount | 1060.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 495 |
| Number Of Medicare Beneficiaries With Medical Services | 150 |
| Total Medical Submitted Charge Amount | 101485 |
| Total Medical Medicare Allowed Amount | 41554.17 |
| Total Medical Medicare Payment Amount | 29069.46 |
| Total Medical Medicare Standardized Payment Amount | 27426.76 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 46 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| 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 | 136 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9477 |