| National Provider Identifier [NPI]: | 1609862242 |
| Last Name Of The Provider | WADA |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2103 MONTROSE AVE |
| Street Address 2 Of The Provider | SUITE D |
| City Of The Provider | MONTROSE |
| Zip Code Of The Provider | 910201546 |
| 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 | 71 |
| Number Of Services | 5543 |
| Number Of Medicare Beneficiaries | 694 |
| Total Submitted Charge Amount | 419175 |
| Total Medicare Allowed Amount | 390696.8 |
| Total Medicare Payment Amount | 287956.05 |
| Total Medicare Standardized Payment Amount | 260714.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 149 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 370 |
| Total Drug Medicare AllowedAmount | 301.89 |
| Total Drug Medicare PaymentAmount | 232.46 |
| Total Drug Medicare Standardized Payment Amount | 232.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 5394 |
| Number Of Medicare Beneficiaries With Medical Services | 694 |
| Total Medical Submitted Charge Amount | 418805 |
| Total Medical Medicare Allowed Amount | 390394.91 |
| Total Medical Medicare Payment Amount | 287723.59 |
| Total Medical Medicare Standardized Payment Amount | 260482.17 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 311 |
| Number Of Beneficiaries Age 75 to 84 | 250 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 400 |
| Number Of Male Beneficiaries | 294 |
| Number Of Non Hispanic White Beneficiaries | 599 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 624 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1009 |