| National Provider Identifier [NPI]: | 1134187594 |
| Last Name Of The Provider | CRANE |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1099 MEDICAL CENTER DR |
| Street Address 2 Of The Provider | DERMONE OF NORTH CAROLINA |
| City Of The Provider | WILMINGTON |
| Zip Code Of The Provider | 284017346 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 11392 |
| Number Of Medicare Beneficiaries | 1589 |
| Total Submitted Charge Amount | 1935304 |
| Total Medicare Allowed Amount | 687639.24 |
| Total Medicare Payment Amount | 503780.83 |
| Total Medicare Standardized Payment Amount | 517089.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 165 |
| Total Drug Medicare AllowedAmount | 39.14 |
| Total Drug Medicare PaymentAmount | 27.92 |
| Total Drug Medicare Standardized Payment Amount | 27.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 11370 |
| Number Of Medicare Beneficiaries With Medical Services | 1589 |
| Total Medical Submitted Charge Amount | 1935139 |
| Total Medical Medicare Allowed Amount | 687600.1 |
| Total Medical Medicare Payment Amount | 503752.91 |
| Total Medical Medicare Standardized Payment Amount | 517062.05 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 141 |
| Number Of Beneficiaries Age 65 to 74 | 987 |
| Number Of Beneficiaries Age 75 to 84 | 350 |
| Number Of Beneficiaries Age Greater 84 | 111 |
| Number Of Female Beneficiaries | 800 |
| Number Of Male Beneficiaries | 789 |
| Number Of Non Hispanic White Beneficiaries | 1454 |
| Number Of Black or African American Beneficiaries | 91 |
| 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 | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1467 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8905 |