| National Provider Identifier [NPI]: | 1801072855 |
| Last Name Of The Provider | JAN |
| First Name Of The Provider | MOLLIE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3010 WILLIAMS DR STE 210 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GEORGETOWN |
| Zip Code Of The Provider | 786282787 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 9332 |
| Number Of Medicare Beneficiaries | 1535 |
| Total Submitted Charge Amount | 880241.5 |
| Total Medicare Allowed Amount | 502024.57 |
| Total Medicare Payment Amount | 360146.01 |
| Total Medicare Standardized Payment Amount | 378231.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 333.5 |
| Total Drug Medicare AllowedAmount | 103.46 |
| Total Drug Medicare PaymentAmount | 81.12 |
| Total Drug Medicare Standardized Payment Amount | 81.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 9274 |
| Number Of Medicare Beneficiaries With Medical Services | 1535 |
| Total Medical Submitted Charge Amount | 879908 |
| Total Medical Medicare Allowed Amount | 501921.11 |
| Total Medical Medicare Payment Amount | 360064.89 |
| Total Medical Medicare Standardized Payment Amount | 378150.48 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 766 |
| Number Of Beneficiaries Age 75 to 84 | 536 |
| Number Of Beneficiaries Age Greater 84 | 192 |
| Number Of Female Beneficiaries | 919 |
| Number Of Male Beneficiaries | 616 |
| Number Of Non Hispanic White Beneficiaries | 1487 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1460 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8735 |