| National Provider Identifier [NPI]: | 1700828290 |
| Last Name Of The Provider | MACINNIS |
| First Name Of The Provider | COLLEEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4120 CORLEY ISLAND RD |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | LEESBURG |
| Zip Code Of The Provider | 347488292 |
| 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 | 104 |
| Number Of Services | 15270 |
| Number Of Medicare Beneficiaries | 2585 |
| Total Submitted Charge Amount | 1635011 |
| Total Medicare Allowed Amount | 1192874.44 |
| Total Medicare Payment Amount | 889129.21 |
| Total Medicare Standardized Payment Amount | 875445.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 92 |
| Number Of Medicare Beneficiaries With Drug Services | 76 |
| Total Drug Submitted ChargeAmount | 14089 |
| Total Drug Medicare AllowedAmount | 12867 |
| Total Drug Medicare PaymentAmount | 10052.92 |
| Total Drug Medicare Standardized Payment Amount | 10052.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 102 |
| Number Of Medical Services | 15178 |
| Number Of Medicare Beneficiaries With Medical Services | 2585 |
| Total Medical Submitted Charge Amount | 1620922 |
| Total Medical Medicare Allowed Amount | 1180007.44 |
| Total Medical Medicare Payment Amount | 879076.29 |
| Total Medical Medicare Standardized Payment Amount | 865392.41 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 1320 |
| Number Of Beneficiaries Age 75 to 84 | 944 |
| Number Of Beneficiaries Age Greater 84 | 266 |
| Number Of Female Beneficiaries | 1423 |
| Number Of Male Beneficiaries | 1162 |
| Number Of Non Hispanic White Beneficiaries | 2510 |
| 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 | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2548 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9869 |