| National Provider Identifier [NPI]: | 1265501779 |
| Last Name Of The Provider | PROCTOR |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3015 HIGHWAY 95 |
| Street Address 2 Of The Provider | #110 |
| City Of The Provider | BULLHEAD CITY |
| Zip Code Of The Provider | 86442 |
| 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 | 98 |
| Number Of Services | 27957 |
| Number Of Medicare Beneficiaries | 2509 |
| Total Submitted Charge Amount | 1954748.28 |
| Total Medicare Allowed Amount | 1775870.31 |
| Total Medicare Payment Amount | 1292463.73 |
| Total Medicare Standardized Payment Amount | 1289259.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1758 |
| Number Of Medicare Beneficiaries With Drug Services | 281 |
| Total Drug Submitted ChargeAmount | 10380.26 |
| Total Drug Medicare AllowedAmount | 10100.34 |
| Total Drug Medicare PaymentAmount | 7565.67 |
| Total Drug Medicare Standardized Payment Amount | 7565.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 26199 |
| Number Of Medicare Beneficiaries With Medical Services | 2509 |
| Total Medical Submitted Charge Amount | 1944368.02 |
| Total Medical Medicare Allowed Amount | 1765769.97 |
| Total Medical Medicare Payment Amount | 1284898.06 |
| Total Medical Medicare Standardized Payment Amount | 1281693.47 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 1152 |
| Number Of Beneficiaries Age 75 to 84 | 978 |
| Number Of Beneficiaries Age Greater 84 | 311 |
| Number Of Female Beneficiaries | 1190 |
| Number Of Male Beneficiaries | 1319 |
| Number Of Non Hispanic White Beneficiaries | 2386 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2430 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 79 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0469 |