| National Provider Identifier [NPI]: | 1962493445 |
| Last Name Of The Provider | COTHERN |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4201 CAMP BOWIE BLVD |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761073928 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 10115 |
| Number Of Medicare Beneficiaries | 1489 |
| Total Submitted Charge Amount | 991962 |
| Total Medicare Allowed Amount | 554847.26 |
| Total Medicare Payment Amount | 396923.21 |
| Total Medicare Standardized Payment Amount | 398974.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 658 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 10330 |
| Total Drug Medicare AllowedAmount | 1280.33 |
| Total Drug Medicare PaymentAmount | 929.58 |
| Total Drug Medicare Standardized Payment Amount | 929.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 9457 |
| Number Of Medicare Beneficiaries With Medical Services | 1489 |
| Total Medical Submitted Charge Amount | 981632 |
| Total Medical Medicare Allowed Amount | 553566.93 |
| Total Medical Medicare Payment Amount | 395993.63 |
| Total Medical Medicare Standardized Payment Amount | 398044.55 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 730 |
| Number Of Beneficiaries Age 75 to 84 | 528 |
| Number Of Beneficiaries Age Greater 84 | 164 |
| Number Of Female Beneficiaries | 673 |
| Number Of Male Beneficiaries | 816 |
| Number Of Non Hispanic White Beneficiaries | 1392 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1445 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0438 |