| National Provider Identifier [NPI]: | 1992772628 |
| Last Name Of The Provider | EVERTS |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5100 GAMBLE DR SUITE 100 - MAIL STOP 31200A |
| Street Address 2 Of The Provider | HEALTHPARTNERS WEST CLINIC |
| City Of The Provider | ST. LOUIS PARK |
| Zip Code Of The Provider | 554161582 |
| 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 | 246 |
| Number Of Medicare Beneficiaries | 51 |
| Total Submitted Charge Amount | 33278 |
| Total Medicare Allowed Amount | 12483.25 |
| Total Medicare Payment Amount | 8566.84 |
| Total Medicare Standardized Payment Amount | 8918.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 571 |
| Total Drug Medicare AllowedAmount | 387.08 |
| Total Drug Medicare PaymentAmount | 213.78 |
| Total Drug Medicare Standardized Payment Amount | 213.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 208 |
| Number Of Medicare Beneficiaries With Medical Services | 51 |
| Total Medical Submitted Charge Amount | 32707 |
| Total Medical Medicare Allowed Amount | 12096.17 |
| Total Medical Medicare Payment Amount | 8353.06 |
| Total Medical Medicare Standardized Payment Amount | 8704.42 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 17 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 23 |
| Number Of Male Beneficiaries | 28 |
| 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 | 36 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 0 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8466 |