| National Provider Identifier [NPI]: | 1265490429 |
| Last Name Of The Provider | OLMEDO |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14800 W MOUNTAIN VIEW BLVD |
| Street Address 2 Of The Provider | SUITE 160 |
| City Of The Provider | SURPRISE |
| Zip Code Of The Provider | 853742700 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 9274 |
| Number Of Medicare Beneficiaries | 1649 |
| Total Submitted Charge Amount | 787820.82 |
| Total Medicare Allowed Amount | 522421.87 |
| Total Medicare Payment Amount | 368402.83 |
| Total Medicare Standardized Payment Amount | 362096.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 209.99 |
| Total Drug Medicare AllowedAmount | 209.87 |
| Total Drug Medicare PaymentAmount | 164.53 |
| Total Drug Medicare Standardized Payment Amount | 164.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 9253 |
| Number Of Medicare Beneficiaries With Medical Services | 1649 |
| Total Medical Submitted Charge Amount | 787610.83 |
| Total Medical Medicare Allowed Amount | 522212 |
| Total Medical Medicare Payment Amount | 368238.3 |
| Total Medical Medicare Standardized Payment Amount | 361931.57 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 789 |
| Number Of Beneficiaries Age 75 to 84 | 629 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 702 |
| Number Of Male Beneficiaries | 947 |
| Number Of Non Hispanic White Beneficiaries | 1592 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.01 |