| National Provider Identifier [NPI]: | 1295918597 |
| Last Name Of The Provider | KASSOUF |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1611 S GREEN RD |
| Street Address 2 Of The Provider | SUITE 146 |
| City Of The Provider | SOUTH EUCLID |
| Zip Code Of The Provider | 441214128 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 1916 |
| Number Of Medicare Beneficiaries | 469 |
| Total Submitted Charge Amount | 176822.89 |
| Total Medicare Allowed Amount | 105867.78 |
| Total Medicare Payment Amount | 75030.59 |
| Total Medicare Standardized Payment Amount | 77576.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 79 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 3612 |
| Total Drug Medicare AllowedAmount | 3353.04 |
| Total Drug Medicare PaymentAmount | 2614.08 |
| Total Drug Medicare Standardized Payment Amount | 2614.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 1837 |
| Number Of Medicare Beneficiaries With Medical Services | 469 |
| Total Medical Submitted Charge Amount | 173210.89 |
| Total Medical Medicare Allowed Amount | 102514.74 |
| Total Medical Medicare Payment Amount | 72416.51 |
| Total Medical Medicare Standardized Payment Amount | 74961.99 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 223 |
| Number Of Beneficiaries Age 75 to 84 | 160 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 307 |
| Number Of Male Beneficiaries | 162 |
| Number Of Non Hispanic White Beneficiaries | 449 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 454 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.894 |