| National Provider Identifier [NPI]: | 1245270842 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2315 E HARMONY RD |
| Street Address 2 Of The Provider | SUITE 140 |
| City Of The Provider | FORT COLLINS |
| Zip Code Of The Provider | 805288620 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 2632 |
| Number Of Medicare Beneficiaries | 465 |
| Total Submitted Charge Amount | 500314.5 |
| Total Medicare Allowed Amount | 243550.44 |
| Total Medicare Payment Amount | 184279.14 |
| Total Medicare Standardized Payment Amount | 186604.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 930 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 49190 |
| Total Drug Medicare AllowedAmount | 27052.21 |
| Total Drug Medicare PaymentAmount | 21055.46 |
| Total Drug Medicare Standardized Payment Amount | 21055.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 1702 |
| Number Of Medicare Beneficiaries With Medical Services | 465 |
| Total Medical Submitted Charge Amount | 451124.5 |
| Total Medical Medicare Allowed Amount | 216498.23 |
| Total Medical Medicare Payment Amount | 163223.68 |
| Total Medical Medicare Standardized Payment Amount | 165548.73 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 241 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 101 |
| Number Of Male Beneficiaries | 364 |
| Number Of Non Hispanic White Beneficiaries | 432 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 427 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 30 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1117 |