| National Provider Identifier [NPI]: | 1033168794 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | ALVA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1845 W ORANGE GROVE RD |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 857041134 |
| 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 | 37 |
| Number Of Services | 2134 |
| Number Of Medicare Beneficiaries | 562 |
| Total Submitted Charge Amount | 219291 |
| Total Medicare Allowed Amount | 124184.78 |
| Total Medicare Payment Amount | 86780.96 |
| Total Medicare Standardized Payment Amount | 87470.28 |
| Drug Suppress Indicator | * |
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| Number Of Medicare Beneficiaries With Drug Services | |
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| 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 | 73 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 296 |
| Number Of Beneficiaries Age 75 to 84 | 167 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 280 |
| Number Of Male Beneficiaries | 282 |
| Number Of Non Hispanic White Beneficiaries | 498 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 488 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0449 |