| National Provider Identifier [NPI]: | 1447233754 |
| Last Name Of The Provider | BAKER |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 984 WEST BROADWAY |
| Street Address 2 Of The Provider | SUITE 4 |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 830010000 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 2183 |
| Number Of Medicare Beneficiaries | 368 |
| Total Submitted Charge Amount | 297399 |
| Total Medicare Allowed Amount | 129011.82 |
| Total Medicare Payment Amount | 91381.6 |
| Total Medicare Standardized Payment Amount | 89173.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 41 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 9373 |
| Total Drug Medicare AllowedAmount | 7685.48 |
| Total Drug Medicare PaymentAmount | 5943.2 |
| Total Drug Medicare Standardized Payment Amount | 5943.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 2142 |
| Number Of Medicare Beneficiaries With Medical Services | 368 |
| Total Medical Submitted Charge Amount | 288026 |
| Total Medical Medicare Allowed Amount | 121326.34 |
| Total Medical Medicare Payment Amount | 85438.4 |
| Total Medical Medicare Standardized Payment Amount | 83230.43 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 234 |
| Number Of Beneficiaries Age 75 to 84 | 87 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 207 |
| Number Of Non Hispanic White Beneficiaries | 354 |
| 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 | 355 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 4 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 8 |
| Percent Of With Hyperlipidemia | 27 |
| Percent Of With Hypertension | 34 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6727 |