| National Provider Identifier [NPI]: | 1679554133 |
| Last Name Of The Provider | CORNITIUS |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 CENTRAL AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DODGE CITY |
| Zip Code Of The Provider | 678011000 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 7132 |
| Number Of Medicare Beneficiaries | 997 |
| Total Submitted Charge Amount | 592267 |
| Total Medicare Allowed Amount | 269248.68 |
| Total Medicare Payment Amount | 185940.05 |
| Total Medicare Standardized Payment Amount | 195165.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 751 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 7837 |
| Total Drug Medicare AllowedAmount | 6881.53 |
| Total Drug Medicare PaymentAmount | 5183.49 |
| Total Drug Medicare Standardized Payment Amount | 5183.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 6381 |
| Number Of Medicare Beneficiaries With Medical Services | 997 |
| Total Medical Submitted Charge Amount | 584430 |
| Total Medical Medicare Allowed Amount | 262367.15 |
| Total Medical Medicare Payment Amount | 180756.56 |
| Total Medical Medicare Standardized Payment Amount | 189982.37 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 423 |
| Number Of Beneficiaries Age 75 to 84 | 390 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 498 |
| Number Of Male Beneficiaries | 499 |
| Number Of Non Hispanic White Beneficiaries | 966 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 954 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9378 |