| National Provider Identifier [NPI]: | 1063780187 |
| Last Name Of The Provider | GUTIERREZ |
| First Name Of The Provider | MARCELLA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MPAS, PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6413 OAK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH BRANCH |
| Zip Code Of The Provider | 550565129 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 675 |
| Number Of Medicare Beneficiaries | 128 |
| Total Submitted Charge Amount | 60780.9 |
| Total Medicare Allowed Amount | 23130.3 |
| Total Medicare Payment Amount | 15319.41 |
| Total Medicare Standardized Payment Amount | 19248.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 205 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1705.9 |
| Total Drug Medicare AllowedAmount | 1319.75 |
| Total Drug Medicare PaymentAmount | 1276.72 |
| Total Drug Medicare Standardized Payment Amount | 1276.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 470 |
| Number Of Medicare Beneficiaries With Medical Services | 128 |
| Total Medical Submitted Charge Amount | 59075 |
| Total Medical Medicare Allowed Amount | 21810.55 |
| Total Medical Medicare Payment Amount | 14042.69 |
| Total Medical Medicare Standardized Payment Amount | 17971.91 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 39 |
| 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 | 76 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1362 |