| National Provider Identifier [NPI]: | 1821092859 |
| Last Name Of The Provider | CAPODANNO |
| First Name Of The Provider | CARMEN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1360 W 6TH ST |
| Street Address 2 Of The Provider | STE 270 |
| City Of The Provider | SAN PEDRO |
| Zip Code Of The Provider | 907323539 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 8535 |
| Number Of Medicare Beneficiaries | 931 |
| Total Submitted Charge Amount | 348989.93 |
| Total Medicare Allowed Amount | 334975.17 |
| Total Medicare Payment Amount | 247035.28 |
| Total Medicare Standardized Payment Amount | 228219.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 551 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 1011 |
| Total Drug Medicare AllowedAmount | 982.88 |
| Total Drug Medicare PaymentAmount | 749.81 |
| Total Drug Medicare Standardized Payment Amount | 749.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 7984 |
| Number Of Medicare Beneficiaries With Medical Services | 931 |
| Total Medical Submitted Charge Amount | 347978.93 |
| Total Medical Medicare Allowed Amount | 333992.29 |
| Total Medical Medicare Payment Amount | 246285.47 |
| Total Medical Medicare Standardized Payment Amount | 227470.16 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 309 |
| Number Of Beneficiaries Age 75 to 84 | 362 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 460 |
| Number Of Male Beneficiaries | 471 |
| Number Of Non Hispanic White Beneficiaries | 796 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 85 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 800 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 131 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2052 |