| National Provider Identifier [NPI]: | 1346304540 |
| Last Name Of The Provider | FORMAN |
| First Name Of The Provider | SETH |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4915 EHRLICH RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336242038 |
| 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 | 96 |
| Number Of Services | 13330 |
| Number Of Medicare Beneficiaries | 1605 |
| Total Submitted Charge Amount | 2004164 |
| Total Medicare Allowed Amount | 970817.21 |
| Total Medicare Payment Amount | 737954.49 |
| Total Medicare Standardized Payment Amount | 665030.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 4840 |
| Total Drug Medicare AllowedAmount | 3517.52 |
| Total Drug Medicare PaymentAmount | 2756.26 |
| Total Drug Medicare Standardized Payment Amount | 2756.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 13280 |
| Number Of Medicare Beneficiaries With Medical Services | 1605 |
| Total Medical Submitted Charge Amount | 1999324 |
| Total Medical Medicare Allowed Amount | 967299.69 |
| Total Medical Medicare Payment Amount | 735198.23 |
| Total Medical Medicare Standardized Payment Amount | 662274.03 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 570 |
| Number Of Beneficiaries Age 75 to 84 | 428 |
| Number Of Beneficiaries Age Greater 84 | 523 |
| Number Of Female Beneficiaries | 914 |
| Number Of Male Beneficiaries | 691 |
| Number Of Non Hispanic White Beneficiaries | 1481 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 78 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1357 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 248 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4688 |