| National Provider Identifier [NPI]: | 1528066073 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | BRADLEY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1480 S WICKHAM RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST MELBOURNE |
| Zip Code Of The Provider | 329042447 |
| 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 | 77 |
| Number Of Services | 7781 |
| Number Of Medicare Beneficiaries | 1492 |
| Total Submitted Charge Amount | 1603242.87 |
| Total Medicare Allowed Amount | 754668.62 |
| Total Medicare Payment Amount | 555273.9 |
| Total Medicare Standardized Payment Amount | 558759.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 624 |
| Total Drug Medicare AllowedAmount | 35.88 |
| Total Drug Medicare PaymentAmount | 22.44 |
| Total Drug Medicare Standardized Payment Amount | 22.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 7761 |
| Number Of Medicare Beneficiaries With Medical Services | 1492 |
| Total Medical Submitted Charge Amount | 1602618.87 |
| Total Medical Medicare Allowed Amount | 754632.74 |
| Total Medical Medicare Payment Amount | 555251.46 |
| Total Medical Medicare Standardized Payment Amount | 558736.69 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 597 |
| Number Of Beneficiaries Age 75 to 84 | 598 |
| Number Of Beneficiaries Age Greater 84 | 247 |
| Number Of Female Beneficiaries | 759 |
| Number Of Male Beneficiaries | 733 |
| Number Of Non Hispanic White Beneficiaries | 1444 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1441 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1192 |