| National Provider Identifier [NPI]: | 1538289012 |
| Last Name Of The Provider | YOUSE |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 W UNIVERSITY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHAMPAIGN |
| Zip Code Of The Provider | 618203909 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 5672 |
| Number Of Medicare Beneficiaries | 678 |
| Total Submitted Charge Amount | 3611340 |
| Total Medicare Allowed Amount | 849656.15 |
| Total Medicare Payment Amount | 652804.9 |
| Total Medicare Standardized Payment Amount | 649401.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 123 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 36291 |
| Total Drug Medicare AllowedAmount | 22269.03 |
| Total Drug Medicare PaymentAmount | 17437.27 |
| Total Drug Medicare Standardized Payment Amount | 17437.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 5549 |
| Number Of Medicare Beneficiaries With Medical Services | 678 |
| Total Medical Submitted Charge Amount | 3575049 |
| Total Medical Medicare Allowed Amount | 827387.12 |
| Total Medical Medicare Payment Amount | 635367.63 |
| Total Medical Medicare Standardized Payment Amount | 631964.41 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 302 |
| Number Of Beneficiaries Age 75 to 84 | 232 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 315 |
| Number Of Male Beneficiaries | 363 |
| Number Of Non Hispanic White Beneficiaries | 662 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 630 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0242 |