| National Provider Identifier [NPI]: | 1003884339 |
| Last Name Of The Provider | CORNELISON |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3727 NW 63RD ST STE 205 |
| Street Address 2 Of The Provider | |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731161923 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 4509 |
| Number Of Medicare Beneficiaries | 742 |
| Total Submitted Charge Amount | 222360.51 |
| Total Medicare Allowed Amount | 191369.35 |
| Total Medicare Payment Amount | 134468.6 |
| Total Medicare Standardized Payment Amount | 152695.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 145.69 |
| Total Drug Medicare AllowedAmount | 118.42 |
| Total Drug Medicare PaymentAmount | 81.41 |
| Total Drug Medicare Standardized Payment Amount | 81.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 4442 |
| Number Of Medicare Beneficiaries With Medical Services | 742 |
| Total Medical Submitted Charge Amount | 222214.82 |
| Total Medical Medicare Allowed Amount | 191250.93 |
| Total Medical Medicare Payment Amount | 134387.19 |
| Total Medical Medicare Standardized Payment Amount | 152613.96 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 328 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 356 |
| Number Of Male Beneficiaries | 386 |
| Number Of Non Hispanic White Beneficiaries | 680 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 25 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 676 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0093 |