| National Provider Identifier [NPI]: | 1104814235 |
| Last Name Of The Provider | SPENCER |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1617 TAMIAMI TRL |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 339481040 |
| 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 | 99 |
| Number Of Services | 19034 |
| Number Of Medicare Beneficiaries | 3685 |
| Total Submitted Charge Amount | 2000424.97 |
| Total Medicare Allowed Amount | 1762226.36 |
| Total Medicare Payment Amount | 1305378.48 |
| Total Medicare Standardized Payment Amount | 1301738.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 73 |
| Total Drug Submitted ChargeAmount | 18877.2 |
| Total Drug Medicare AllowedAmount | 18822.8 |
| Total Drug Medicare PaymentAmount | 14490.14 |
| Total Drug Medicare Standardized Payment Amount | 14490.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 18958 |
| Number Of Medicare Beneficiaries With Medical Services | 3685 |
| Total Medical Submitted Charge Amount | 1981547.77 |
| Total Medical Medicare Allowed Amount | 1743403.56 |
| Total Medical Medicare Payment Amount | 1290888.34 |
| Total Medical Medicare Standardized Payment Amount | 1287248.66 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 94 |
| Number Of Beneficiaries Age 65 to 74 | 1572 |
| Number Of Beneficiaries Age 75 to 84 | 1470 |
| Number Of Beneficiaries Age Greater 84 | 549 |
| Number Of Female Beneficiaries | 1574 |
| Number Of Male Beneficiaries | 2111 |
| Number Of Non Hispanic White Beneficiaries | 3590 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 50 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3611 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0801 |