| National Provider Identifier [NPI]: | 1275529224 |
| Last Name Of The Provider | HALEY |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3480 WOLVERINE DR |
| Street Address 2 Of The Provider | SUITE F |
| City Of The Provider | MONTROSE |
| Zip Code Of The Provider | 814014965 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 3256 |
| Number Of Medicare Beneficiaries | 557 |
| Total Submitted Charge Amount | 402026.52 |
| Total Medicare Allowed Amount | 189442.91 |
| Total Medicare Payment Amount | 129365.64 |
| Total Medicare Standardized Payment Amount | 127001.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 9225 |
| Total Drug Medicare AllowedAmount | 6755.98 |
| Total Drug Medicare PaymentAmount | 5101.7 |
| Total Drug Medicare Standardized Payment Amount | 5101.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 3193 |
| Number Of Medicare Beneficiaries With Medical Services | 557 |
| Total Medical Submitted Charge Amount | 392801.52 |
| Total Medical Medicare Allowed Amount | 182686.93 |
| Total Medical Medicare Payment Amount | 124263.94 |
| Total Medical Medicare Standardized Payment Amount | 121899.91 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 348 |
| Number Of Beneficiaries Age 75 to 84 | 147 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 303 |
| Number Of Male Beneficiaries | 254 |
| Number Of Non Hispanic White Beneficiaries | 530 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 536 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 12 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 34 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6997 |