| National Provider Identifier [NPI]: | 1144214016 |
| Last Name Of The Provider | KALLGREN |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3434 47TH ST |
| Street Address 2 Of The Provider | #200 |
| City Of The Provider | BOULDER |
| Zip Code Of The Provider | 803011880 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 4428 |
| Number Of Medicare Beneficiaries | 855 |
| Total Submitted Charge Amount | 507390.25 |
| Total Medicare Allowed Amount | 209827.45 |
| Total Medicare Payment Amount | 150896.22 |
| Total Medicare Standardized Payment Amount | 153750.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1592 |
| Total Drug Medicare AllowedAmount | 1265.73 |
| Total Drug Medicare PaymentAmount | 981.52 |
| Total Drug Medicare Standardized Payment Amount | 981.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 4404 |
| Number Of Medicare Beneficiaries With Medical Services | 855 |
| Total Medical Submitted Charge Amount | 505798.25 |
| Total Medical Medicare Allowed Amount | 208561.72 |
| Total Medical Medicare Payment Amount | 149914.7 |
| Total Medical Medicare Standardized Payment Amount | 152768.94 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 493 |
| Number Of Beneficiaries Age 75 to 84 | 240 |
| Number Of Beneficiaries Age Greater 84 | 99 |
| Number Of Female Beneficiaries | 514 |
| Number Of Male Beneficiaries | 341 |
| Number Of Non Hispanic White Beneficiaries | 825 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 841 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 4 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 8 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 31 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7405 |