| National Provider Identifier [NPI]: | 1255347779 |
| Last Name Of The Provider | DANNENBERG |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 177 MAIN STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | HUNTINGTON |
| Zip Code Of The Provider | 117436951 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 5667 |
| Number Of Medicare Beneficiaries | 1301 |
| Total Submitted Charge Amount | 545615 |
| Total Medicare Allowed Amount | 440683.16 |
| Total Medicare Payment Amount | 327855.97 |
| Total Medicare Standardized Payment Amount | 279003.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 72 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 10220 |
| Total Drug Medicare AllowedAmount | 9401.95 |
| Total Drug Medicare PaymentAmount | 7381.69 |
| Total Drug Medicare Standardized Payment Amount | 7381.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 5595 |
| Number Of Medicare Beneficiaries With Medical Services | 1301 |
| Total Medical Submitted Charge Amount | 535395 |
| Total Medical Medicare Allowed Amount | 431281.21 |
| Total Medical Medicare Payment Amount | 320474.28 |
| Total Medical Medicare Standardized Payment Amount | 271621.89 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 479 |
| Number Of Beneficiaries Age 75 to 84 | 529 |
| Number Of Beneficiaries Age Greater 84 | 247 |
| Number Of Female Beneficiaries | 677 |
| Number Of Male Beneficiaries | 624 |
| Number Of Non Hispanic White Beneficiaries | 1259 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1242 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1172 |