| National Provider Identifier [NPI]: | 1710047097 |
| Last Name Of The Provider | HERBST |
| First Name Of The Provider | JAY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2866 TAMIAMI TRL STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 339525165 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 12178 |
| Number Of Medicare Beneficiaries | 1286 |
| Total Submitted Charge Amount | 1543922.04 |
| Total Medicare Allowed Amount | 892485.77 |
| Total Medicare Payment Amount | 679987.77 |
| Total Medicare Standardized Payment Amount | 674480.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 116 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 3985 |
| Total Drug Medicare AllowedAmount | 1357.55 |
| Total Drug Medicare PaymentAmount | 1050.83 |
| Total Drug Medicare Standardized Payment Amount | 1050.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 12062 |
| Number Of Medicare Beneficiaries With Medical Services | 1286 |
| Total Medical Submitted Charge Amount | 1539937.04 |
| Total Medical Medicare Allowed Amount | 891128.22 |
| Total Medical Medicare Payment Amount | 678936.94 |
| Total Medical Medicare Standardized Payment Amount | 673429.42 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 335 |
| Number Of Beneficiaries Age 75 to 84 | 628 |
| Number Of Beneficiaries Age Greater 84 | 309 |
| Number Of Female Beneficiaries | 636 |
| Number Of Male Beneficiaries | 650 |
| Number Of Non Hispanic White Beneficiaries | 1264 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1267 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1221 |