| National Provider Identifier [NPI]: | 1194719294 |
| Last Name Of The Provider | RAVERTY |
| First Name Of The Provider | RITA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1687 E DIVISION ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RIVER FALLS |
| Zip Code Of The Provider | 540221571 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 1171 |
| Number Of Medicare Beneficiaries | 235 |
| Total Submitted Charge Amount | 153883.74 |
| Total Medicare Allowed Amount | 52493.64 |
| Total Medicare Payment Amount | 38436.75 |
| Total Medicare Standardized Payment Amount | 40442.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 388 |
| Number Of Medicare Beneficiaries With Drug Services | 65 |
| Total Drug Submitted ChargeAmount | 2750.59 |
| Total Drug Medicare AllowedAmount | 1572.33 |
| Total Drug Medicare PaymentAmount | 1428.05 |
| Total Drug Medicare Standardized Payment Amount | 1428.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 783 |
| Number Of Medicare Beneficiaries With Medical Services | 234 |
| Total Medical Submitted Charge Amount | 151133.15 |
| Total Medical Medicare Allowed Amount | 50921.31 |
| Total Medical Medicare Payment Amount | 37008.7 |
| Total Medical Medicare Standardized Payment Amount | 39014.89 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 89 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 174 |
| Number Of Male Beneficiaries | 61 |
| 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 | 205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9852 |