| National Provider Identifier [NPI]: | 1790792851 |
| Last Name Of The Provider | GAUGHAN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 523B SOUTH CAMINO DEL RIO |
| Street Address 2 Of The Provider | |
| City Of The Provider | DURANGO |
| Zip Code Of The Provider | 813036853 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 13186 |
| Number Of Medicare Beneficiaries | 1960 |
| Total Submitted Charge Amount | 1600074.21 |
| Total Medicare Allowed Amount | 853043.21 |
| Total Medicare Payment Amount | 622758.6 |
| Total Medicare Standardized Payment Amount | 586301.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 248 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 22209 |
| Total Drug Medicare AllowedAmount | 18621.86 |
| Total Drug Medicare PaymentAmount | 12784.42 |
| Total Drug Medicare Standardized Payment Amount | 12784.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 12938 |
| Number Of Medicare Beneficiaries With Medical Services | 1960 |
| Total Medical Submitted Charge Amount | 1577865.21 |
| Total Medical Medicare Allowed Amount | 834421.35 |
| Total Medical Medicare Payment Amount | 609974.18 |
| Total Medical Medicare Standardized Payment Amount | 573517.24 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 1007 |
| Number Of Beneficiaries Age 75 to 84 | 663 |
| Number Of Beneficiaries Age Greater 84 | 242 |
| Number Of Female Beneficiaries | 866 |
| Number Of Male Beneficiaries | 1094 |
| Number Of Non Hispanic White Beneficiaries | 1878 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1889 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8839 |