| National Provider Identifier [NPI]: | 1215931993 |
| Last Name Of The Provider | WILLOUGHBY |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 319 F ST |
| Street Address 2 Of The Provider | STE 102 |
| City Of The Provider | CHULA VISTA |
| Zip Code Of The Provider | 919102666 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 7232 |
| Number Of Medicare Beneficiaries | 1259 |
| Total Submitted Charge Amount | 4995837 |
| Total Medicare Allowed Amount | 3405815.63 |
| Total Medicare Payment Amount | 2642064.49 |
| Total Medicare Standardized Payment Amount | 2610889.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 12714 |
| Total Drug Medicare AllowedAmount | 10536.58 |
| Total Drug Medicare PaymentAmount | 8251.4 |
| Total Drug Medicare Standardized Payment Amount | 8251.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 7187 |
| Number Of Medicare Beneficiaries With Medical Services | 1259 |
| Total Medical Submitted Charge Amount | 4983123 |
| Total Medical Medicare Allowed Amount | 3395279.05 |
| Total Medical Medicare Payment Amount | 2633813.09 |
| Total Medical Medicare Standardized Payment Amount | 2602638.2 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 439 |
| Number Of Beneficiaries Age 75 to 84 | 438 |
| Number Of Beneficiaries Age Greater 84 | 271 |
| Number Of Female Beneficiaries | 570 |
| Number Of Male Beneficiaries | 689 |
| Number Of Non Hispanic White Beneficiaries | 1037 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 49 |
| Number Of Hispanic Beneficiaries | 110 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1023 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 236 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2198 |