| National Provider Identifier [NPI]: | 1841262136 |
| Last Name Of The Provider | SIMONSSON |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1900 16TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREELEY |
| Zip Code Of The Provider | 806315114 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 672 |
| Number Of Medicare Beneficiaries | 123 |
| Total Submitted Charge Amount | 164228.43 |
| Total Medicare Allowed Amount | 29205.37 |
| Total Medicare Payment Amount | 21973.92 |
| Total Medicare Standardized Payment Amount | 23987.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 379 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 21637.43 |
| Total Drug Medicare AllowedAmount | 6621.06 |
| Total Drug Medicare PaymentAmount | 5179.9 |
| Total Drug Medicare Standardized Payment Amount | 5179.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 293 |
| Number Of Medicare Beneficiaries With Medical Services | 123 |
| Total Medical Submitted Charge Amount | 142591 |
| Total Medical Medicare Allowed Amount | 22584.31 |
| Total Medical Medicare Payment Amount | 16794.02 |
| Total Medical Medicare Standardized Payment Amount | 18807.32 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 80 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | 99 |
| 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 | 102 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.204 |