| National Provider Identifier [NPI]: | 1215965181 |
| Last Name Of The Provider | LONG |
| First Name Of The Provider | ERIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3333 CATTLEMEN RD |
| Street Address 2 Of The Provider | SUITE 106 |
| City Of The Provider | SARASOTA |
| Zip Code Of The Provider | 342326056 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 10407 |
| Number Of Medicare Beneficiaries | 1637 |
| Total Submitted Charge Amount | 1292628 |
| Total Medicare Allowed Amount | 580117.53 |
| Total Medicare Payment Amount | 412919.37 |
| Total Medicare Standardized Payment Amount | 413188.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 625 |
| Total Drug Medicare AllowedAmount | 99.26 |
| Total Drug Medicare PaymentAmount | 82.39 |
| Total Drug Medicare Standardized Payment Amount | 82.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 10384 |
| Number Of Medicare Beneficiaries With Medical Services | 1636 |
| Total Medical Submitted Charge Amount | 1292003 |
| Total Medical Medicare Allowed Amount | 580018.27 |
| Total Medical Medicare Payment Amount | 412836.98 |
| Total Medical Medicare Standardized Payment Amount | 413106.35 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 914 |
| Number Of Beneficiaries Age 75 to 84 | 502 |
| Number Of Beneficiaries Age Greater 84 | 182 |
| Number Of Female Beneficiaries | 1002 |
| Number Of Male Beneficiaries | 635 |
| Number Of Non Hispanic White Beneficiaries | 1569 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1596 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8592 |