| National Provider Identifier [NPI]: | 1154578797 |
| Last Name Of The Provider | SICA |
| First Name Of The Provider | ROGER |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1104 MEDICAL CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILMINGTON |
| Zip Code Of The Provider | 284017305 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 9817 |
| Number Of Medicare Beneficiaries | 1985 |
| Total Submitted Charge Amount | 3388164 |
| Total Medicare Allowed Amount | 1118320.13 |
| Total Medicare Payment Amount | 851195.6 |
| Total Medicare Standardized Payment Amount | 862927.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 120 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 1300 |
| Total Drug Medicare AllowedAmount | 488.35 |
| Total Drug Medicare PaymentAmount | 267.55 |
| Total Drug Medicare Standardized Payment Amount | 267.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 9697 |
| Number Of Medicare Beneficiaries With Medical Services | 1985 |
| Total Medical Submitted Charge Amount | 3386864 |
| Total Medical Medicare Allowed Amount | 1117831.78 |
| Total Medical Medicare Payment Amount | 850928.05 |
| Total Medical Medicare Standardized Payment Amount | 862659.74 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 1065 |
| Number Of Beneficiaries Age 75 to 84 | 621 |
| Number Of Beneficiaries Age Greater 84 | 206 |
| Number Of Female Beneficiaries | 902 |
| Number Of Male Beneficiaries | 1083 |
| Number Of Non Hispanic White Beneficiaries | 1898 |
| Number Of Black or African American Beneficiaries | 46 |
| 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 | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1853 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 132 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8909 |