| National Provider Identifier [NPI]: | 1700861382 |
| Last Name Of The Provider | RUDOLPH |
| First Name Of The Provider | THEODOR |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1850 43RD AVE |
| Street Address 2 Of The Provider | SUITES 4 & 5 C |
| City Of The Provider | VERO BEACH |
| Zip Code Of The Provider | 329600504 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 21200 |
| Number Of Medicare Beneficiaries | 3404 |
| Total Submitted Charge Amount | 1206079.86 |
| Total Medicare Allowed Amount | 1138752.17 |
| Total Medicare Payment Amount | 827568.9 |
| Total Medicare Standardized Payment Amount | 768208.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 123 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 266 |
| Total Drug Medicare AllowedAmount | 219.86 |
| Total Drug Medicare PaymentAmount | 162.66 |
| Total Drug Medicare Standardized Payment Amount | 162.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 21077 |
| Number Of Medicare Beneficiaries With Medical Services | 3404 |
| Total Medical Submitted Charge Amount | 1205813.86 |
| Total Medical Medicare Allowed Amount | 1138532.31 |
| Total Medical Medicare Payment Amount | 827406.24 |
| Total Medical Medicare Standardized Payment Amount | 768046.28 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 1648 |
| Number Of Beneficiaries Age 75 to 84 | 1208 |
| Number Of Beneficiaries Age Greater 84 | 468 |
| Number Of Female Beneficiaries | 1854 |
| Number Of Male Beneficiaries | 1550 |
| Number Of Non Hispanic White Beneficiaries | 3309 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 54 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3311 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 93 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9599 |