| National Provider Identifier [NPI]: | 1093921025 |
| Last Name Of The Provider | BRAGG |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 50 SEWALL STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 04102 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 4634 |
| Number Of Medicare Beneficiaries | 769 |
| Total Submitted Charge Amount | 514296 |
| Total Medicare Allowed Amount | 248634.42 |
| Total Medicare Payment Amount | 181823.07 |
| Total Medicare Standardized Payment Amount | 177141.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 385 |
| Total Drug Medicare AllowedAmount | 270.46 |
| Total Drug Medicare PaymentAmount | 152.44 |
| Total Drug Medicare Standardized Payment Amount | 152.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 4621 |
| Number Of Medicare Beneficiaries With Medical Services | 769 |
| Total Medical Submitted Charge Amount | 513911 |
| Total Medical Medicare Allowed Amount | 248363.96 |
| Total Medical Medicare Payment Amount | 181670.63 |
| Total Medical Medicare Standardized Payment Amount | 176988.94 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 350 |
| Number Of Beneficiaries Age 75 to 84 | 266 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 546 |
| Number Of Male Beneficiaries | 223 |
| Number Of Non Hispanic White Beneficiaries | 750 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 643 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 126 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9273 |