| National Provider Identifier [NPI]: | 1871540377 |
| Last Name Of The Provider | PRODANOVICH |
| First Name Of The Provider | SRDJAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 90 CYPRESS WAY E |
| Street Address 2 Of The Provider | SUITE 50 |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341109275 |
| 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 | 101 |
| Number Of Services | 8805 |
| Number Of Medicare Beneficiaries | 1070 |
| Total Submitted Charge Amount | 1117337.03 |
| Total Medicare Allowed Amount | 665145.78 |
| Total Medicare Payment Amount | 490143.5 |
| Total Medicare Standardized Payment Amount | 456205.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 5162 |
| Total Drug Medicare AllowedAmount | 4693.02 |
| Total Drug Medicare PaymentAmount | 3653.59 |
| Total Drug Medicare Standardized Payment Amount | 3653.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 8778 |
| Number Of Medicare Beneficiaries With Medical Services | 1070 |
| Total Medical Submitted Charge Amount | 1112175.03 |
| Total Medical Medicare Allowed Amount | 660452.76 |
| Total Medical Medicare Payment Amount | 486489.91 |
| Total Medical Medicare Standardized Payment Amount | 452552.07 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 528 |
| Number Of Beneficiaries Age 75 to 84 | 375 |
| Number Of Beneficiaries Age Greater 84 | 141 |
| Number Of Female Beneficiaries | 515 |
| Number Of Male Beneficiaries | 555 |
| Number Of Non Hispanic White Beneficiaries | 1036 |
| Number Of Black or African American Beneficiaries | |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1055 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9965 |