| National Provider Identifier [NPI]: | 1194720276 |
| Last Name Of The Provider | GILDENBERG |
| First Name Of The Provider | STUART |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11900 E 12 MILE RD |
| Street Address 2 Of The Provider | STE 201 |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 480933490 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 7180 |
| Number Of Medicare Beneficiaries | 1680 |
| Total Submitted Charge Amount | 705285.87 |
| Total Medicare Allowed Amount | 434288.28 |
| Total Medicare Payment Amount | 322426.12 |
| Total Medicare Standardized Payment Amount | 309493.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 182 |
| Number Of Medicare Beneficiaries With Drug Services | 94 |
| Total Drug Submitted ChargeAmount | 2691.81 |
| Total Drug Medicare AllowedAmount | 496.11 |
| Total Drug Medicare PaymentAmount | 378.91 |
| Total Drug Medicare Standardized Payment Amount | 378.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 6998 |
| Number Of Medicare Beneficiaries With Medical Services | 1680 |
| Total Medical Submitted Charge Amount | 702594.06 |
| Total Medical Medicare Allowed Amount | 433792.17 |
| Total Medical Medicare Payment Amount | 322047.21 |
| Total Medical Medicare Standardized Payment Amount | 309114.72 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 193 |
| Number Of Beneficiaries Age 65 to 74 | 655 |
| Number Of Beneficiaries Age 75 to 84 | 578 |
| Number Of Beneficiaries Age Greater 84 | 254 |
| Number Of Female Beneficiaries | 860 |
| Number Of Male Beneficiaries | 820 |
| Number Of Non Hispanic White Beneficiaries | 1554 |
| Number Of Black or African American Beneficiaries | 75 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1475 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 205 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2933 |