| National Provider Identifier [NPI]: | 1023213634 |
| Last Name Of The Provider | GREEN |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1707 RIGGINS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TALLAHASSEE |
| Zip Code Of The Provider | 323085317 |
| 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 | 98 |
| Number Of Services | 10315 |
| Number Of Medicare Beneficiaries | 1453 |
| Total Submitted Charge Amount | 4483437 |
| Total Medicare Allowed Amount | 1825312.94 |
| Total Medicare Payment Amount | 1403146.29 |
| Total Medicare Standardized Payment Amount | 1263664.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 12992 |
| Total Drug Medicare AllowedAmount | 10664.99 |
| Total Drug Medicare PaymentAmount | 8346.09 |
| Total Drug Medicare Standardized Payment Amount | 8346.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 10257 |
| Number Of Medicare Beneficiaries With Medical Services | 1453 |
| Total Medical Submitted Charge Amount | 4470445 |
| Total Medical Medicare Allowed Amount | 1814647.95 |
| Total Medical Medicare Payment Amount | 1394800.2 |
| Total Medical Medicare Standardized Payment Amount | 1255318.89 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 630 |
| Number Of Beneficiaries Age Greater 84 | 309 |
| Number Of Female Beneficiaries | 620 |
| Number Of Male Beneficiaries | 833 |
| Number Of Non Hispanic White Beneficiaries | 1425 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1357 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0847 |