| National Provider Identifier [NPI]: | 1295735322 |
| Last Name Of The Provider | GOTTLIEB |
| First Name Of The Provider | ANNETTE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8920 WILSHIRE BLVD |
| Street Address 2 Of The Provider | #545 |
| City Of The Provider | BEVERLY HILLS |
| Zip Code Of The Provider | 902112007 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 15772 |
| Number Of Medicare Beneficiaries | 1296 |
| Total Submitted Charge Amount | 1079695.1 |
| Total Medicare Allowed Amount | 837293.23 |
| Total Medicare Payment Amount | 624342.19 |
| Total Medicare Standardized Payment Amount | 576037.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 60 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 720 |
| Total Drug Medicare AllowedAmount | 106.68 |
| Total Drug Medicare PaymentAmount | 82.23 |
| Total Drug Medicare Standardized Payment Amount | 82.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 15712 |
| Number Of Medicare Beneficiaries With Medical Services | 1296 |
| Total Medical Submitted Charge Amount | 1078975.1 |
| Total Medical Medicare Allowed Amount | 837186.55 |
| Total Medical Medicare Payment Amount | 624259.96 |
| Total Medical Medicare Standardized Payment Amount | 575954.9 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 500 |
| Number Of Beneficiaries Age 75 to 84 | 435 |
| Number Of Beneficiaries Age Greater 84 | 318 |
| Number Of Female Beneficiaries | 884 |
| Number Of Male Beneficiaries | 412 |
| Number Of Non Hispanic White Beneficiaries | 1232 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1210 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.086 |