| National Provider Identifier [NPI]: | 1730116872 |
| Last Name Of The Provider | DAVENPORT |
| First Name Of The Provider | CHARLES |
| 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 | 512 NOKOMIS AVE S |
| Street Address 2 Of The Provider | |
| City Of The Provider | VENICE |
| Zip Code Of The Provider | 342852817 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 254 |
| Number Of Services | 117202.5 |
| Number Of Medicare Beneficiaries | 7049 |
| Total Submitted Charge Amount | 1608041.94 |
| Total Medicare Allowed Amount | 1332289.04 |
| Total Medicare Payment Amount | 1053959.37 |
| Total Medicare Standardized Payment Amount | 1089329.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 103768.5 |
| Number Of Medicare Beneficiaries With Drug Services | 1111 |
| Total Drug Submitted ChargeAmount | 85284.4 |
| Total Drug Medicare AllowedAmount | 27128.32 |
| Total Drug Medicare PaymentAmount | 21183.81 |
| Total Drug Medicare Standardized Payment Amount | 21183.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 243 |
| Number Of Medical Services | 13434 |
| Number Of Medicare Beneficiaries With Medical Services | 7048 |
| Total Medical Submitted Charge Amount | 1522757.54 |
| Total Medical Medicare Allowed Amount | 1305160.72 |
| Total Medical Medicare Payment Amount | 1032775.56 |
| Total Medical Medicare Standardized Payment Amount | 1068146.09 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 342 |
| Number Of Beneficiaries Age 65 to 74 | 2709 |
| Number Of Beneficiaries Age 75 to 84 | 2611 |
| Number Of Beneficiaries Age Greater 84 | 1387 |
| Number Of Female Beneficiaries | 4244 |
| Number Of Male Beneficiaries | 2805 |
| Number Of Non Hispanic White Beneficiaries | 6850 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 77 |
| Number Of Beneficiaries With Medicare Only Entitlement | 6592 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 457 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3402 |