| National Provider Identifier [NPI]: | 1396704649 |
| Last Name Of The Provider | HENNER |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2850 MORNINGSIDE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT DORA |
| Zip Code Of The Provider | 327576610 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 19843 |
| Number Of Medicare Beneficiaries | 5243 |
| Total Submitted Charge Amount | 2236889 |
| Total Medicare Allowed Amount | 1332416.41 |
| Total Medicare Payment Amount | 1000122.95 |
| Total Medicare Standardized Payment Amount | 758527.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 163 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 9931 |
| Total Drug Medicare AllowedAmount | 9413 |
| Total Drug Medicare PaymentAmount | 6954.6 |
| Total Drug Medicare Standardized Payment Amount | 6954.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 19680 |
| Number Of Medicare Beneficiaries With Medical Services | 5243 |
| Total Medical Submitted Charge Amount | 2226958 |
| Total Medical Medicare Allowed Amount | 1323003.41 |
| Total Medical Medicare Payment Amount | 993168.35 |
| Total Medical Medicare Standardized Payment Amount | 751573.11 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 2070 |
| Number Of Beneficiaries Age 75 to 84 | 2027 |
| Number Of Beneficiaries Age Greater 84 | 1042 |
| Number Of Female Beneficiaries | 2570 |
| Number Of Male Beneficiaries | 2673 |
| Number Of Non Hispanic White Beneficiaries | 5110 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 5124 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0741 |