| National Provider Identifier [NPI]: | 1104894872 |
| Last Name Of The Provider | GREEN |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 BRICK RD |
| Street Address 2 Of The Provider | SUITE 306 |
| City Of The Provider | MARLTON |
| Zip Code Of The Provider | 080532146 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 5035 |
| Number Of Medicare Beneficiaries | 1118 |
| Total Submitted Charge Amount | 418954.94 |
| Total Medicare Allowed Amount | 303619.7 |
| Total Medicare Payment Amount | 223090.37 |
| Total Medicare Standardized Payment Amount | 202888.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 230 |
| Total Drug Medicare AllowedAmount | 120.73 |
| Total Drug Medicare PaymentAmount | 86.11 |
| Total Drug Medicare Standardized Payment Amount | 86.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 4999 |
| Number Of Medicare Beneficiaries With Medical Services | 1118 |
| Total Medical Submitted Charge Amount | 418724.94 |
| Total Medical Medicare Allowed Amount | 303498.97 |
| Total Medical Medicare Payment Amount | 223004.26 |
| Total Medical Medicare Standardized Payment Amount | 202802.28 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 518 |
| Number Of Beneficiaries Age 75 to 84 | 323 |
| Number Of Beneficiaries Age Greater 84 | 126 |
| Number Of Female Beneficiaries | 603 |
| Number Of Male Beneficiaries | 515 |
| Number Of Non Hispanic White Beneficiaries | 949 |
| Number Of Black or African American Beneficiaries | 64 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 915 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 203 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1184 |