| National Provider Identifier [NPI]: | 1184604217 |
| Last Name Of The Provider | DACEY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2950 RESEARCH PARK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOQUEL |
| Zip Code Of The Provider | 950732000 |
| 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 | 70 |
| Number Of Services | 4288 |
| Number Of Medicare Beneficiaries | 1086 |
| Total Submitted Charge Amount | 2679797 |
| Total Medicare Allowed Amount | 703618.49 |
| Total Medicare Payment Amount | 534571.33 |
| Total Medicare Standardized Payment Amount | 474199.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 9989 |
| Total Drug Medicare AllowedAmount | 5469.05 |
| Total Drug Medicare PaymentAmount | 4052.91 |
| Total Drug Medicare Standardized Payment Amount | 4052.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 4257 |
| Number Of Medicare Beneficiaries With Medical Services | 1086 |
| Total Medical Submitted Charge Amount | 2669808 |
| Total Medical Medicare Allowed Amount | 698149.44 |
| Total Medical Medicare Payment Amount | 530518.42 |
| Total Medical Medicare Standardized Payment Amount | 470147.05 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 562 |
| Number Of Beneficiaries Age 75 to 84 | 303 |
| Number Of Beneficiaries Age Greater 84 | 178 |
| Number Of Female Beneficiaries | 513 |
| Number Of Male Beneficiaries | 573 |
| Number Of Non Hispanic White Beneficiaries | 1009 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1026 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9033 |