| National Provider Identifier [NPI]: | 1184600165 |
| Last Name Of The Provider | ROSS |
| First Name Of The Provider | KIM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1303 MCCULLOUGH AVE |
| Street Address 2 Of The Provider | SUITE 525 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782125609 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 10633 |
| Number Of Medicare Beneficiaries | 1398 |
| Total Submitted Charge Amount | 630361.46 |
| Total Medicare Allowed Amount | 536082.12 |
| Total Medicare Payment Amount | 391131.09 |
| Total Medicare Standardized Payment Amount | 413993.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 250.24 |
| Total Drug Medicare AllowedAmount | 189.05 |
| Total Drug Medicare PaymentAmount | 143.72 |
| Total Drug Medicare Standardized Payment Amount | 143.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 10589 |
| Number Of Medicare Beneficiaries With Medical Services | 1398 |
| Total Medical Submitted Charge Amount | 630111.22 |
| Total Medical Medicare Allowed Amount | 535893.07 |
| Total Medical Medicare Payment Amount | 390987.37 |
| Total Medical Medicare Standardized Payment Amount | 413849.96 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 129 |
| Number Of Beneficiaries Age 65 to 74 | 613 |
| Number Of Beneficiaries Age 75 to 84 | 470 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 811 |
| Number Of Male Beneficiaries | 587 |
| Number Of Non Hispanic White Beneficiaries | 929 |
| Number Of Black or African American Beneficiaries | 51 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 407 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1200 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 198 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1383 |