| National Provider Identifier [NPI]: | 1750383667 |
| Last Name Of The Provider | VICKERMAN |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 322 BEARD CREEK RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | EDWARDS |
| Zip Code Of The Provider | 81632 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 641 |
| Number Of Medicare Beneficiaries | 131 |
| Total Submitted Charge Amount | 68328 |
| Total Medicare Allowed Amount | 36613.03 |
| Total Medicare Payment Amount | 28847.73 |
| Total Medicare Standardized Payment Amount | 29086.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1144 |
| Total Drug Medicare AllowedAmount | 1093.75 |
| Total Drug Medicare PaymentAmount | 1070.45 |
| Total Drug Medicare Standardized Payment Amount | 1070.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 617 |
| Number Of Medicare Beneficiaries With Medical Services | 131 |
| Total Medical Submitted Charge Amount | 67184 |
| Total Medical Medicare Allowed Amount | 35519.28 |
| Total Medical Medicare Payment Amount | 27777.28 |
| Total Medical Medicare Standardized Payment Amount | 28016.25 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 105 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 36 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.5779 |