| National Provider Identifier [NPI]: | 1164406849 |
| Last Name Of The Provider | KLINE |
| First Name Of The Provider | SALLY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8455 FLYING CLOUD DR |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | EDEN PRAIRIE |
| Zip Code Of The Provider | 553443974 |
| 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 | 38 |
| Number Of Services | 719 |
| Number Of Medicare Beneficiaries | 96 |
| Total Submitted Charge Amount | 67634.3 |
| Total Medicare Allowed Amount | 29529.52 |
| Total Medicare Payment Amount | 22060.06 |
| Total Medicare Standardized Payment Amount | 22704.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 3211 |
| Total Drug Medicare AllowedAmount | 2047.19 |
| Total Drug Medicare PaymentAmount | 2005.33 |
| Total Drug Medicare Standardized Payment Amount | 2005.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 685 |
| Number Of Medicare Beneficiaries With Medical Services | 96 |
| Total Medical Submitted Charge Amount | 64423.3 |
| Total Medical Medicare Allowed Amount | 27482.33 |
| Total Medical Medicare Payment Amount | 20054.73 |
| Total Medical Medicare Standardized Payment Amount | 20699.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 24 |
| 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 | 78 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9177 |