| National Provider Identifier [NPI]: | 1578567343 |
| Last Name Of The Provider | MCTIGUE |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 S ROGERS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 474034792 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 22126 |
| Number Of Medicare Beneficiaries | 2949 |
| Total Submitted Charge Amount | 3920724 |
| Total Medicare Allowed Amount | 1494595.03 |
| Total Medicare Payment Amount | 1094512.78 |
| Total Medicare Standardized Payment Amount | 1132110.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 786 |
| Number Of Medicare Beneficiaries With Drug Services | 251 |
| Total Drug Submitted ChargeAmount | 48640 |
| Total Drug Medicare AllowedAmount | 43138.73 |
| Total Drug Medicare PaymentAmount | 31751.95 |
| Total Drug Medicare Standardized Payment Amount | 31751.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 137 |
| Number Of Medical Services | 21340 |
| Number Of Medicare Beneficiaries With Medical Services | 2949 |
| Total Medical Submitted Charge Amount | 3872084 |
| Total Medical Medicare Allowed Amount | 1451456.3 |
| Total Medical Medicare Payment Amount | 1062760.83 |
| Total Medical Medicare Standardized Payment Amount | 1100358.6 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 123 |
| Number Of Beneficiaries Age 65 to 74 | 1216 |
| Number Of Beneficiaries Age 75 to 84 | 1113 |
| Number Of Beneficiaries Age Greater 84 | 497 |
| Number Of Female Beneficiaries | 1512 |
| Number Of Male Beneficiaries | 1437 |
| Number Of Non Hispanic White Beneficiaries | 2897 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2777 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 172 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0017 |