| National Provider Identifier [NPI]: | 1508848144 |
| Last Name Of The Provider | HOUSHOLDER |
| First Name Of The Provider | MARTHA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 835 N HILLSIDE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672144913 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 13324 |
| Number Of Medicare Beneficiaries | 1944 |
| Total Submitted Charge Amount | 1243918.5 |
| Total Medicare Allowed Amount | 586279.65 |
| Total Medicare Payment Amount | 426323.85 |
| Total Medicare Standardized Payment Amount | 447292.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 204 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 10190 |
| Total Drug Medicare AllowedAmount | 9906.12 |
| Total Drug Medicare PaymentAmount | 7688.83 |
| Total Drug Medicare Standardized Payment Amount | 7688.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 101 |
| Number Of Medical Services | 13120 |
| Number Of Medicare Beneficiaries With Medical Services | 1943 |
| Total Medical Submitted Charge Amount | 1233728.5 |
| Total Medical Medicare Allowed Amount | 576373.53 |
| Total Medical Medicare Payment Amount | 418635.02 |
| Total Medical Medicare Standardized Payment Amount | 439603.93 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 691 |
| Number Of Beneficiaries Age 75 to 84 | 738 |
| Number Of Beneficiaries Age Greater 84 | 439 |
| Number Of Female Beneficiaries | 1108 |
| Number Of Male Beneficiaries | 836 |
| Number Of Non Hispanic White Beneficiaries | 1879 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1883 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0645 |