| National Provider Identifier [NPI]: | 1679520977 |
| Last Name Of The Provider | HERMANSEN |
| First Name Of The Provider | DANE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 CLYDE MORRIS BLVD |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | ORMOND BEACH |
| Zip Code Of The Provider | 321745956 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 12329 |
| Number Of Medicare Beneficiaries | 1498 |
| Total Submitted Charge Amount | 1366321 |
| Total Medicare Allowed Amount | 449444.69 |
| Total Medicare Payment Amount | 339866.97 |
| Total Medicare Standardized Payment Amount | 342116.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 2466 |
| Number Of Medicare Beneficiaries With Drug Services | 91 |
| Total Drug Submitted ChargeAmount | 219826 |
| Total Drug Medicare AllowedAmount | 62095.7 |
| Total Drug Medicare PaymentAmount | 48326.66 |
| Total Drug Medicare Standardized Payment Amount | 48326.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 9863 |
| Number Of Medicare Beneficiaries With Medical Services | 1498 |
| Total Medical Submitted Charge Amount | 1146495 |
| Total Medical Medicare Allowed Amount | 387348.99 |
| Total Medical Medicare Payment Amount | 291540.31 |
| Total Medical Medicare Standardized Payment Amount | 293790.13 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 630 |
| Number Of Beneficiaries Age 75 to 84 | 626 |
| Number Of Beneficiaries Age Greater 84 | 198 |
| Number Of Female Beneficiaries | 285 |
| Number Of Male Beneficiaries | 1213 |
| Number Of Non Hispanic White Beneficiaries | 1323 |
| Number Of Black or African American Beneficiaries | 87 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1470 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0652 |