| National Provider Identifier [NPI]: | 1265407852 |
| Last Name Of The Provider | HERTEN |
| First Name Of The Provider | ROBERT |
| 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 | 15 SANTA ROSA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN LUIS OBISPO |
| Zip Code Of The Provider | 934051811 |
| 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 | 94 |
| Number Of Services | 8236 |
| Number Of Medicare Beneficiaries | 1141 |
| Total Submitted Charge Amount | 571883.36 |
| Total Medicare Allowed Amount | 530909.83 |
| Total Medicare Payment Amount | 388177.18 |
| Total Medicare Standardized Payment Amount | 361832.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 396 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 3730.13 |
| Total Drug Medicare AllowedAmount | 3718.4 |
| Total Drug Medicare PaymentAmount | 2821.08 |
| Total Drug Medicare Standardized Payment Amount | 2821.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 7840 |
| Number Of Medicare Beneficiaries With Medical Services | 1141 |
| Total Medical Submitted Charge Amount | 568153.23 |
| Total Medical Medicare Allowed Amount | 527191.43 |
| Total Medical Medicare Payment Amount | 385356.1 |
| Total Medical Medicare Standardized Payment Amount | 359011.45 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 459 |
| Number Of Beneficiaries Age 75 to 84 | 395 |
| Number Of Beneficiaries Age Greater 84 | 272 |
| Number Of Female Beneficiaries | 635 |
| Number Of Male Beneficiaries | 506 |
| Number Of Non Hispanic White Beneficiaries | 1092 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1121 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9233 |