| National Provider Identifier [NPI]: | 1356324495 |
| Last Name Of The Provider | STOLLER |
| First Name Of The Provider | HERSCHEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10110 NICHOLAS ST |
| Street Address 2 Of The Provider | SUITE #103 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681142184 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 8423 |
| Number Of Medicare Beneficiaries | 1092 |
| Total Submitted Charge Amount | 998958.85 |
| Total Medicare Allowed Amount | 453358.24 |
| Total Medicare Payment Amount | 322821.11 |
| Total Medicare Standardized Payment Amount | 348617.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2089 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 6633.85 |
| Total Drug Medicare AllowedAmount | 1607.79 |
| Total Drug Medicare PaymentAmount | 1116.04 |
| Total Drug Medicare Standardized Payment Amount | 1116.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 6334 |
| Number Of Medicare Beneficiaries With Medical Services | 1092 |
| Total Medical Submitted Charge Amount | 992325 |
| Total Medical Medicare Allowed Amount | 451750.45 |
| Total Medical Medicare Payment Amount | 321705.07 |
| Total Medical Medicare Standardized Payment Amount | 347501.11 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 460 |
| Number Of Beneficiaries Age 75 to 84 | 367 |
| Number Of Beneficiaries Age Greater 84 | 161 |
| Number Of Female Beneficiaries | 589 |
| Number Of Male Beneficiaries | 503 |
| Number Of Non Hispanic White Beneficiaries | 1018 |
| Number Of Black or African American Beneficiaries | 38 |
| 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 | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 963 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9196 |