| National Provider Identifier [NPI]: | 1083727747 |
| Last Name Of The Provider | DALTON |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 707 LAKE COOK ROAD |
| Street Address 2 Of The Provider | SUITE #280 |
| City Of The Provider | DEERFIELD |
| Zip Code Of The Provider | 600154909 |
| 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 | 70 |
| Number Of Services | 13394 |
| Number Of Medicare Beneficiaries | 1602 |
| Total Submitted Charge Amount | 1851223 |
| Total Medicare Allowed Amount | 988857.27 |
| Total Medicare Payment Amount | 741613.38 |
| Total Medicare Standardized Payment Amount | 624682.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 453 |
| Total Drug Medicare AllowedAmount | 220.69 |
| Total Drug Medicare PaymentAmount | 166.23 |
| Total Drug Medicare Standardized Payment Amount | 166.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 13374 |
| Number Of Medicare Beneficiaries With Medical Services | 1602 |
| Total Medical Submitted Charge Amount | 1850770 |
| Total Medical Medicare Allowed Amount | 988636.58 |
| Total Medical Medicare Payment Amount | 741447.15 |
| Total Medical Medicare Standardized Payment Amount | 624516.04 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 690 |
| Number Of Beneficiaries Age 75 to 84 | 626 |
| Number Of Beneficiaries Age Greater 84 | 249 |
| Number Of Female Beneficiaries | 703 |
| Number Of Male Beneficiaries | 899 |
| Number Of Non Hispanic White Beneficiaries | 1541 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1539 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9327 |