| National Provider Identifier [NPI]: | 1831150507 |
| Last Name Of The Provider | CULLIMORE |
| First Name Of The Provider | KIP |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8381 RIVERWALK PARK BLVD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339198760 |
| 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 | 50 |
| Number Of Services | 15077 |
| Number Of Medicare Beneficiaries | 1720 |
| Total Submitted Charge Amount | 1228835 |
| Total Medicare Allowed Amount | 806703.6 |
| Total Medicare Payment Amount | 598173.46 |
| Total Medicare Standardized Payment Amount | 559014.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 11310 |
| Total Drug Medicare AllowedAmount | 10238.76 |
| Total Drug Medicare PaymentAmount | 7506.2 |
| Total Drug Medicare Standardized Payment Amount | 7506.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 15019 |
| Number Of Medicare Beneficiaries With Medical Services | 1720 |
| Total Medical Submitted Charge Amount | 1217525 |
| Total Medical Medicare Allowed Amount | 796464.84 |
| Total Medical Medicare Payment Amount | 590667.26 |
| Total Medical Medicare Standardized Payment Amount | 551508.22 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 635 |
| Number Of Beneficiaries Age 75 to 84 | 675 |
| Number Of Beneficiaries Age Greater 84 | 371 |
| Number Of Female Beneficiaries | 818 |
| Number Of Male Beneficiaries | 902 |
| Number Of Non Hispanic White Beneficiaries | 1682 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1684 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0677 |