| National Provider Identifier [NPI]: | 1063606614 |
| Last Name Of The Provider | DEMENKOW |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PH.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 940 E CYPRESS CREEK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FT LAUDERDALE |
| Zip Code Of The Provider | 333344110 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Clinical Psychologist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 3 |
| Number Of Services | 1656 |
| Number Of Medicare Beneficiaries | 219 |
| Total Submitted Charge Amount | 211850 |
| Total Medicare Allowed Amount | 133653.87 |
| Total Medicare Payment Amount | 104525.36 |
| Total Medicare Standardized Payment Amount | 101138.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 3 |
| Number Of Medical Services | 1656 |
| Number Of Medicare Beneficiaries With Medical Services | 219 |
| Total Medical Submitted Charge Amount | 211850 |
| Total Medical Medicare Allowed Amount | 133653.87 |
| Total Medical Medicare Payment Amount | 104525.36 |
| Total Medical Medicare Standardized Payment Amount | 101138.25 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 56 |
| Number Of Beneficiaries Age Greater 84 | 94 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| Number Of Black or African American Beneficiaries | 24 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 79 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 58 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 34 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.8697 |