| National Provider Identifier [NPI]: | 1366452658 |
| Last Name Of The Provider | NO |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD, PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 192 BLUE RAVINE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FOLSOM |
| Zip Code Of The Provider | 956304893 |
| 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 | 86 |
| Number Of Services | 14585 |
| Number Of Medicare Beneficiaries | 2315 |
| Total Submitted Charge Amount | 1535972.14 |
| Total Medicare Allowed Amount | 1151806.76 |
| Total Medicare Payment Amount | 840311.66 |
| Total Medicare Standardized Payment Amount | 789523.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 10396.6 |
| Total Drug Medicare AllowedAmount | 9981.96 |
| Total Drug Medicare PaymentAmount | 7491.9 |
| Total Drug Medicare Standardized Payment Amount | 7491.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 14470 |
| Number Of Medicare Beneficiaries With Medical Services | 2315 |
| Total Medical Submitted Charge Amount | 1525575.54 |
| Total Medical Medicare Allowed Amount | 1141824.8 |
| Total Medical Medicare Payment Amount | 832819.76 |
| Total Medical Medicare Standardized Payment Amount | 782031.56 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 1198 |
| Number Of Beneficiaries Age 75 to 84 | 769 |
| Number Of Beneficiaries Age Greater 84 | 265 |
| Number Of Female Beneficiaries | 1115 |
| Number Of Male Beneficiaries | 1200 |
| Number Of Non Hispanic White Beneficiaries | 2223 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2262 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 9 |
| 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 | 0.8608 |