| National Provider Identifier [NPI]: | 1457693657 |
| Last Name Of The Provider | FAUKS |
| First Name Of The Provider | CARISSA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | NP-FAMILY |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 CURVE CREST BLVD W |
| Street Address 2 Of The Provider | |
| City Of The Provider | STILLWATER |
| Zip Code Of The Provider | 550826040 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 338 |
| Number Of Medicare Beneficiaries | 153 |
| Total Submitted Charge Amount | 44356.99 |
| Total Medicare Allowed Amount | 14397.67 |
| Total Medicare Payment Amount | 8715.75 |
| Total Medicare Standardized Payment Amount | 12625.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 227 |
| Total Drug Medicare AllowedAmount | 161.61 |
| Total Drug Medicare PaymentAmount | 136.58 |
| Total Drug Medicare Standardized Payment Amount | 136.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 319 |
| Number Of Medicare Beneficiaries With Medical Services | 153 |
| Total Medical Submitted Charge Amount | 44129.99 |
| Total Medical Medicare Allowed Amount | 14236.06 |
| Total Medical Medicare Payment Amount | 8579.17 |
| Total Medical Medicare Standardized Payment Amount | 12488.58 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 95 |
| Number Of Male Beneficiaries | 58 |
| 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 | 131 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0745 |