| National Provider Identifier [NPI]: | 1710056221 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2061 SMOKETREE AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE HAVASU CITY |
| Zip Code Of The Provider | 86403 |
| 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 | 131 |
| Number Of Services | 37548 |
| Number Of Medicare Beneficiaries | 4978 |
| Total Submitted Charge Amount | 2811482.85 |
| Total Medicare Allowed Amount | 2588834.91 |
| Total Medicare Payment Amount | 1910607.8 |
| Total Medicare Standardized Payment Amount | 1872212.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 493 |
| Number Of Medicare Beneficiaries With Drug Services | 185 |
| Total Drug Submitted ChargeAmount | 25542.03 |
| Total Drug Medicare AllowedAmount | 25481.69 |
| Total Drug Medicare PaymentAmount | 19589.09 |
| Total Drug Medicare Standardized Payment Amount | 19589.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 125 |
| Number Of Medical Services | 37055 |
| Number Of Medicare Beneficiaries With Medical Services | 4978 |
| Total Medical Submitted Charge Amount | 2785940.82 |
| Total Medical Medicare Allowed Amount | 2563353.22 |
| Total Medical Medicare Payment Amount | 1891018.71 |
| Total Medical Medicare Standardized Payment Amount | 1852623.37 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 144 |
| Number Of Beneficiaries Age 65 to 74 | 2374 |
| Number Of Beneficiaries Age 75 to 84 | 1910 |
| Number Of Beneficiaries Age Greater 84 | 550 |
| Number Of Female Beneficiaries | 2310 |
| Number Of Male Beneficiaries | 2668 |
| Number Of Non Hispanic White Beneficiaries | 4810 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 95 |
| Number Of American Indian Alaska Native Beneficiaries | 20 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4800 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 178 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0191 |