| National Provider Identifier [NPI]: | 1679682520 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | LANCE |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1444 E STEARNS ST |
| Street Address 2 Of The Provider | SUITE 11 |
| City Of The Provider | FAYETTEVILLE |
| Zip Code Of The Provider | 727036243 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 11748 |
| Number Of Medicare Beneficiaries | 1726 |
| Total Submitted Charge Amount | 2904535.12 |
| Total Medicare Allowed Amount | 1034503.06 |
| Total Medicare Payment Amount | 765039.56 |
| Total Medicare Standardized Payment Amount | 835309.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 139 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 26035 |
| Total Drug Medicare AllowedAmount | 23262.86 |
| Total Drug Medicare PaymentAmount | 17153.3 |
| Total Drug Medicare Standardized Payment Amount | 17153.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 11609 |
| Number Of Medicare Beneficiaries With Medical Services | 1726 |
| Total Medical Submitted Charge Amount | 2878500.12 |
| Total Medical Medicare Allowed Amount | 1011240.2 |
| Total Medical Medicare Payment Amount | 747886.26 |
| Total Medical Medicare Standardized Payment Amount | 818156.15 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 114 |
| Number Of Beneficiaries Age 65 to 74 | 803 |
| Number Of Beneficiaries Age 75 to 84 | 588 |
| Number Of Beneficiaries Age Greater 84 | 221 |
| Number Of Female Beneficiaries | 865 |
| Number Of Male Beneficiaries | 861 |
| Number Of Non Hispanic White Beneficiaries | 1680 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1578 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 148 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9337 |