| National Provider Identifier [NPI]: | 1619991890 |
| Last Name Of The Provider | DOUGHERTY |
| First Name Of The Provider | DANA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6400 DUTCHMANS PKWY |
| Street Address 2 Of The Provider | STE.300 |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402053340 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 1443 |
| Number Of Medicare Beneficiaries | 209 |
| Total Submitted Charge Amount | 96764 |
| Total Medicare Allowed Amount | 65236.35 |
| Total Medicare Payment Amount | 46423.16 |
| Total Medicare Standardized Payment Amount | 50655.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 97 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 5495 |
| Total Drug Medicare AllowedAmount | 3693.54 |
| Total Drug Medicare PaymentAmount | 3596.38 |
| Total Drug Medicare Standardized Payment Amount | 3596.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 1346 |
| Number Of Medicare Beneficiaries With Medical Services | 209 |
| Total Medical Submitted Charge Amount | 91269 |
| Total Medical Medicare Allowed Amount | 61542.81 |
| Total Medical Medicare Payment Amount | 42826.78 |
| Total Medical Medicare Standardized Payment Amount | 47059.35 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 98 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 168 |
| Number Of Male Beneficiaries | 41 |
| Number Of Non Hispanic White Beneficiaries | 181 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 181 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9893 |