| National Provider Identifier [NPI]: | 1073666335 |
| Last Name Of The Provider | GRANDE |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10215 KINGSTON PIKE # 200 |
| Street Address 2 Of The Provider | |
| City Of The Provider | KNOXVILLE |
| Zip Code Of The Provider | 379223222 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 5474 |
| Number Of Medicare Beneficiaries | 1113 |
| Total Submitted Charge Amount | 659886 |
| Total Medicare Allowed Amount | 343093.7 |
| Total Medicare Payment Amount | 248598.96 |
| Total Medicare Standardized Payment Amount | 270029.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 12196 |
| Total Drug Medicare AllowedAmount | 11165.48 |
| Total Drug Medicare PaymentAmount | 8532 |
| Total Drug Medicare Standardized Payment Amount | 8532 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 5406 |
| Number Of Medicare Beneficiaries With Medical Services | 1113 |
| Total Medical Submitted Charge Amount | 647690 |
| Total Medical Medicare Allowed Amount | 331928.22 |
| Total Medical Medicare Payment Amount | 240066.96 |
| Total Medical Medicare Standardized Payment Amount | 261497.03 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 712 |
| Number Of Beneficiaries Age 75 to 84 | 294 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 660 |
| Number Of Male Beneficiaries | 453 |
| Number Of Non Hispanic White Beneficiaries | 1091 |
| 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 | 1092 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7488 |