| National Provider Identifier [NPI]: | 1104856061 |
| Last Name Of The Provider | BAACK |
| First Name Of The Provider | BRAD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1120 E ELIZABETH ST |
| Street Address 2 Of The Provider | SUITE G-2 |
| City Of The Provider | FORT COLLINS |
| Zip Code Of The Provider | 805244044 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 9830 |
| Number Of Medicare Beneficiaries | 1652 |
| Total Submitted Charge Amount | 1847346 |
| Total Medicare Allowed Amount | 1021300.58 |
| Total Medicare Payment Amount | 763393.41 |
| Total Medicare Standardized Payment Amount | 727186.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 111 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 27338 |
| Total Drug Medicare AllowedAmount | 22671.45 |
| Total Drug Medicare PaymentAmount | 17082.96 |
| Total Drug Medicare Standardized Payment Amount | 17082.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 103 |
| Number Of Medical Services | 9719 |
| Number Of Medicare Beneficiaries With Medical Services | 1623 |
| Total Medical Submitted Charge Amount | 1820008 |
| Total Medical Medicare Allowed Amount | 998629.13 |
| Total Medical Medicare Payment Amount | 746310.45 |
| Total Medical Medicare Standardized Payment Amount | 710103.72 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 869 |
| Number Of Beneficiaries Age 75 to 84 | 478 |
| Number Of Beneficiaries Age Greater 84 | 245 |
| Number Of Female Beneficiaries | 785 |
| Number Of Male Beneficiaries | 867 |
| Number Of Non Hispanic White Beneficiaries | 1590 |
| 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 | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1588 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8192 |