| National Provider Identifier [NPI]: | 1639121304 |
| Last Name Of The Provider | MATZKE |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4656 40TH AVE S |
| Street Address 2 Of The Provider | |
| City Of The Provider | FARGO |
| Zip Code Of The Provider | 581044397 |
| State Code Of The Provider | ND |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 4699 |
| Number Of Medicare Beneficiaries | 1040 |
| Total Submitted Charge Amount | 595704.5 |
| Total Medicare Allowed Amount | 417840.78 |
| Total Medicare Payment Amount | 313655.29 |
| Total Medicare Standardized Payment Amount | 311416.92 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
| Total Drug Medicare AllowedAmount | |
| Total Drug Medicare PaymentAmount | |
| Total Drug Medicare Standardized Payment Amount | |
| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 384 |
| Number Of Beneficiaries Age 75 to 84 | 402 |
| Number Of Beneficiaries Age Greater 84 | 214 |
| Number Of Female Beneficiaries | 449 |
| Number Of Male Beneficiaries | 591 |
| Number Of Non Hispanic White Beneficiaries | 1020 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 989 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.0179 |