| National Provider Identifier [NPI]: | 1902830623 |
| Last Name Of The Provider | KOBALTER |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5000 CIVIC CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN RAFAEL |
| Zip Code Of The Provider | 949034184 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 68 |
| Number Of Services | 14334 |
| Number Of Medicare Beneficiaries | 1553 |
| Total Submitted Charge Amount | 1459417 |
| Total Medicare Allowed Amount | 992493.74 |
| Total Medicare Payment Amount | 729221.1 |
| Total Medicare Standardized Payment Amount | 612017.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 30 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 7648 |
| Total Drug Medicare AllowedAmount | 5886.06 |
| Total Drug Medicare PaymentAmount | 4089.92 |
| Total Drug Medicare Standardized Payment Amount | 4089.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 14304 |
| Number Of Medicare Beneficiaries With Medical Services | 1553 |
| Total Medical Submitted Charge Amount | 1451769 |
| Total Medical Medicare Allowed Amount | 986607.68 |
| Total Medical Medicare Payment Amount | 725131.18 |
| Total Medical Medicare Standardized Payment Amount | 607927.28 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 747 |
| Number Of Beneficiaries Age 75 to 84 | 506 |
| Number Of Beneficiaries Age Greater 84 | 269 |
| Number Of Female Beneficiaries | 902 |
| Number Of Male Beneficiaries | 651 |
| Number Of Non Hispanic White Beneficiaries | 1501 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1536 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8026 |