| National Provider Identifier [NPI]: | 1528279189 |
| Last Name Of The Provider | MINER |
| First Name Of The Provider | BRANDON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2085 PROVIDENCE WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | IDAHO FALLS |
| Zip Code Of The Provider | 834044945 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 86 |
| Number Of Services | 4692 |
| Number Of Medicare Beneficiaries | 492 |
| Total Submitted Charge Amount | 517554.19 |
| Total Medicare Allowed Amount | 436201.69 |
| Total Medicare Payment Amount | 330559.97 |
| Total Medicare Standardized Payment Amount | 341596.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 2366 |
| Total Drug Medicare AllowedAmount | 2001.59 |
| Total Drug Medicare PaymentAmount | 1562.25 |
| Total Drug Medicare Standardized Payment Amount | 1562.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 4656 |
| Number Of Medicare Beneficiaries With Medical Services | 492 |
| Total Medical Submitted Charge Amount | 515188.19 |
| Total Medical Medicare Allowed Amount | 434200.1 |
| Total Medical Medicare Payment Amount | 328997.72 |
| Total Medical Medicare Standardized Payment Amount | 340034.58 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 218 |
| Number Of Beneficiaries Age 75 to 84 | 185 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 220 |
| Number Of Male Beneficiaries | 272 |
| Number Of Non Hispanic White Beneficiaries | 480 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 467 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 2 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9728 |