| National Provider Identifier [NPI]: | 1144280181 |
| Last Name Of The Provider | CARLSON |
| First Name Of The Provider | GARY |
| 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 | 1240 S WESTLAKE BLVD |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | WESTLAKE VILLAGE |
| Zip Code Of The Provider | 913611929 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 9659 |
| Number Of Medicare Beneficiaries | 1032 |
| Total Submitted Charge Amount | 840260 |
| Total Medicare Allowed Amount | 580099.69 |
| Total Medicare Payment Amount | 434875.77 |
| Total Medicare Standardized Payment Amount | 408516.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 260 |
| Total Drug Medicare AllowedAmount | 46.42 |
| Total Drug Medicare PaymentAmount | 32.13 |
| Total Drug Medicare Standardized Payment Amount | 32.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 9633 |
| Number Of Medicare Beneficiaries With Medical Services | 1032 |
| Total Medical Submitted Charge Amount | 840000 |
| Total Medical Medicare Allowed Amount | 580053.27 |
| Total Medical Medicare Payment Amount | 434843.64 |
| Total Medical Medicare Standardized Payment Amount | 408484.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 588 |
| Number Of Beneficiaries Age 75 to 84 | 295 |
| Number Of Beneficiaries Age Greater 84 | 112 |
| Number Of Female Beneficiaries | 591 |
| Number Of Male Beneficiaries | 441 |
| Number Of Non Hispanic White Beneficiaries | 985 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1009 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8153 |