| National Provider Identifier [NPI]: | 1255365334 |
| Last Name Of The Provider | DEKKINGA |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4285 PARKWAY PLACE SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRANDVILLE |
| Zip Code Of The Provider | 494182385 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 99 |
| Number Of Services | 1946 |
| Number Of Medicare Beneficiaries | 417 |
| Total Submitted Charge Amount | 734927 |
| Total Medicare Allowed Amount | 329362.41 |
| Total Medicare Payment Amount | 251081.35 |
| Total Medicare Standardized Payment Amount | 245926.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 21165 |
| Total Drug Medicare AllowedAmount | 17060.91 |
| Total Drug Medicare PaymentAmount | 13257.57 |
| Total Drug Medicare Standardized Payment Amount | 13257.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 1870 |
| Number Of Medicare Beneficiaries With Medical Services | 417 |
| Total Medical Submitted Charge Amount | 713762 |
| Total Medical Medicare Allowed Amount | 312301.5 |
| Total Medical Medicare Payment Amount | 237823.78 |
| Total Medical Medicare Standardized Payment Amount | 232668.82 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 137 |
| Number Of Beneficiaries Age 75 to 84 | 149 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 190 |
| Number Of Male Beneficiaries | 227 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 398 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0668 |