| National Provider Identifier [NPI]: | 1518949551 |
| Last Name Of The Provider | ENGSTROM |
| First Name Of The Provider | CONLEY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 26908 DETROIT RD |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | WESTLAKE |
| Zip Code Of The Provider | 441452398 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 4846 |
| Number Of Medicare Beneficiaries | 1190 |
| Total Submitted Charge Amount | 394732 |
| Total Medicare Allowed Amount | 261701.72 |
| Total Medicare Payment Amount | 181189.73 |
| Total Medicare Standardized Payment Amount | 186216.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 1918 |
| Total Drug Medicare AllowedAmount | 1686.88 |
| Total Drug Medicare PaymentAmount | 1280.63 |
| Total Drug Medicare Standardized Payment Amount | 1280.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 4815 |
| Number Of Medicare Beneficiaries With Medical Services | 1190 |
| Total Medical Submitted Charge Amount | 392814 |
| Total Medical Medicare Allowed Amount | 260014.84 |
| Total Medical Medicare Payment Amount | 179909.1 |
| Total Medical Medicare Standardized Payment Amount | 184936.02 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 481 |
| Number Of Beneficiaries Age 75 to 84 | 440 |
| Number Of Beneficiaries Age Greater 84 | 220 |
| Number Of Female Beneficiaries | 512 |
| Number Of Male Beneficiaries | 678 |
| Number Of Non Hispanic White Beneficiaries | 1141 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1139 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9943 |