| National Provider Identifier [NPI]: | 1003995291 |
| Last Name Of The Provider | FREDERICKSON |
| First Name Of The Provider | KIM |
| 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 | 400 PROFESSIONAL CENTER DRIVE |
| Street Address 2 Of The Provider | SUITE 414 NOVATO DERMATOLOGY ASSOCIATES |
| City Of The Provider | NOVATO |
| Zip Code Of The Provider | 94947 |
| 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 | 84 |
| Number Of Services | 5302 |
| Number Of Medicare Beneficiaries | 520 |
| Total Submitted Charge Amount | 554399 |
| Total Medicare Allowed Amount | 381019.05 |
| Total Medicare Payment Amount | 284110.58 |
| Total Medicare Standardized Payment Amount | 240916.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 84 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 714 |
| Total Drug Medicare AllowedAmount | 204.65 |
| Total Drug Medicare PaymentAmount | 154.65 |
| Total Drug Medicare Standardized Payment Amount | 154.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 5218 |
| Number Of Medicare Beneficiaries With Medical Services | 520 |
| Total Medical Submitted Charge Amount | 553685 |
| Total Medical Medicare Allowed Amount | 380814.4 |
| Total Medical Medicare Payment Amount | 283955.93 |
| Total Medical Medicare Standardized Payment Amount | 240762.07 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 265 |
| Number Of Beneficiaries Age 75 to 84 | 166 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 327 |
| Number Of Male Beneficiaries | 193 |
| Number Of Non Hispanic White Beneficiaries | 487 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.824 |