| National Provider Identifier [NPI]: | 1831267459 |
| Last Name Of The Provider | DICKINSON |
| First Name Of The Provider | DENISE |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1700 OLD BLUEGRASS AVE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402151162 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 5458 |
| Number Of Medicare Beneficiaries | 843 |
| Total Submitted Charge Amount | 471154 |
| Total Medicare Allowed Amount | 273581.95 |
| Total Medicare Payment Amount | 201862.13 |
| Total Medicare Standardized Payment Amount | 219915.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 182 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 1456 |
| Total Drug Medicare AllowedAmount | 325.47 |
| Total Drug Medicare PaymentAmount | 203.93 |
| Total Drug Medicare Standardized Payment Amount | 203.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 5276 |
| Number Of Medicare Beneficiaries With Medical Services | 843 |
| Total Medical Submitted Charge Amount | 469698 |
| Total Medical Medicare Allowed Amount | 273256.48 |
| Total Medical Medicare Payment Amount | 201658.2 |
| Total Medical Medicare Standardized Payment Amount | 219711.37 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 374 |
| Number Of Beneficiaries Age 75 to 84 | 262 |
| Number Of Beneficiaries Age Greater 84 | 105 |
| Number Of Female Beneficiaries | 488 |
| Number Of Male Beneficiaries | 355 |
| Number Of Non Hispanic White Beneficiaries | 791 |
| Number Of Black or African American Beneficiaries | 33 |
| 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 | 775 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0263 |