| National Provider Identifier [NPI]: | 1699742957 |
| Last Name Of The Provider | SURBRUGG |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 123 WESTERN HILLS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820093446 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 21430 |
| Number Of Medicare Beneficiaries | 3078 |
| Total Submitted Charge Amount | 2863810 |
| Total Medicare Allowed Amount | 1978536.37 |
| Total Medicare Payment Amount | 1505680.9 |
| Total Medicare Standardized Payment Amount | 1252846.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 794 |
| Number Of Medicare Beneficiaries With Drug Services | 317 |
| Total Drug Submitted ChargeAmount | 132213 |
| Total Drug Medicare AllowedAmount | 130257.45 |
| Total Drug Medicare PaymentAmount | 100340.01 |
| Total Drug Medicare Standardized Payment Amount | 100340.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 20636 |
| Number Of Medicare Beneficiaries With Medical Services | 3076 |
| Total Medical Submitted Charge Amount | 2731597 |
| Total Medical Medicare Allowed Amount | 1848278.92 |
| Total Medical Medicare Payment Amount | 1405340.89 |
| Total Medical Medicare Standardized Payment Amount | 1152506.51 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 156 |
| Number Of Beneficiaries Age 65 to 74 | 1502 |
| Number Of Beneficiaries Age 75 to 84 | 1075 |
| Number Of Beneficiaries Age Greater 84 | 345 |
| Number Of Female Beneficiaries | 1739 |
| Number Of Male Beneficiaries | 1339 |
| Number Of Non Hispanic White Beneficiaries | 2928 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 78 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 50 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2926 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 152 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8309 |