| National Provider Identifier [NPI]: | 1659485746 |
| Last Name Of The Provider | SOEPRONO |
| First Name Of The Provider | FRED |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 255 TERRACINA BLVD |
| Street Address 2 Of The Provider | STE 206 |
| City Of The Provider | REDLANDS |
| Zip Code Of The Provider | 923734870 |
| 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 | 66 |
| Number Of Services | 8310 |
| Number Of Medicare Beneficiaries | 2270 |
| Total Submitted Charge Amount | 787481.5 |
| Total Medicare Allowed Amount | 456848.44 |
| Total Medicare Payment Amount | 335893.11 |
| Total Medicare Standardized Payment Amount | 309979.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 180 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1800 |
| Total Drug Medicare AllowedAmount | 304.8 |
| Total Drug Medicare PaymentAmount | 214.82 |
| Total Drug Medicare Standardized Payment Amount | 214.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 8130 |
| Number Of Medicare Beneficiaries With Medical Services | 2270 |
| Total Medical Submitted Charge Amount | 785681.5 |
| Total Medical Medicare Allowed Amount | 456543.64 |
| Total Medical Medicare Payment Amount | 335678.29 |
| Total Medical Medicare Standardized Payment Amount | 309764.63 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 176 |
| Number Of Beneficiaries Age 65 to 74 | 1031 |
| Number Of Beneficiaries Age 75 to 84 | 709 |
| Number Of Beneficiaries Age Greater 84 | 354 |
| Number Of Female Beneficiaries | 1216 |
| Number Of Male Beneficiaries | 1054 |
| Number Of Non Hispanic White Beneficiaries | 1865 |
| Number Of Black or African American Beneficiaries | 55 |
| Number Of AsianPacific Islander Beneficiaries | 69 |
| Number Of Hispanic Beneficiaries | 233 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1927 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 343 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1198 |