| National Provider Identifier [NPI]: | 1073594966 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | SHELLY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1495 HWY 101 NORTH |
| Street Address 2 Of The Provider | |
| City Of The Provider | PLYMOUTH |
| Zip Code Of The Provider | 55447 |
| 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 | 64 |
| Number Of Services | 592 |
| Number Of Medicare Beneficiaries | 106 |
| Total Submitted Charge Amount | 55668 |
| Total Medicare Allowed Amount | 21558.26 |
| Total Medicare Payment Amount | 15882.56 |
| Total Medicare Standardized Payment Amount | 16112 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 1511 |
| Total Drug Medicare AllowedAmount | 842.63 |
| Total Drug Medicare PaymentAmount | 825.8 |
| Total Drug Medicare Standardized Payment Amount | 825.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 569 |
| Number Of Medicare Beneficiaries With Medical Services | 106 |
| Total Medical Submitted Charge Amount | 54157 |
| Total Medical Medicare Allowed Amount | 20715.63 |
| Total Medical Medicare Payment Amount | 15056.76 |
| Total Medical Medicare Standardized Payment Amount | 15286.2 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 43 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 79 |
| Number Of Male Beneficiaries | 27 |
| 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 | 81 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.288 |