| National Provider Identifier [NPI]: | 1659349991 |
| Last Name Of The Provider | DREVETS |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 711 STANTON L YOUNG BLVD |
| Street Address 2 Of The Provider | PPB SUITE 430 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731045023 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 420 |
| Number Of Medicare Beneficiaries | 128 |
| Total Submitted Charge Amount | 58195 |
| Total Medicare Allowed Amount | 24356.8 |
| Total Medicare Payment Amount | 18010.2 |
| Total Medicare Standardized Payment Amount | 16488.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1926 |
| Total Drug Medicare AllowedAmount | 819.33 |
| Total Drug Medicare PaymentAmount | 802.94 |
| Total Drug Medicare Standardized Payment Amount | 802.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 396 |
| Number Of Medicare Beneficiaries With Medical Services | 128 |
| Total Medical Submitted Charge Amount | 56269 |
| Total Medical Medicare Allowed Amount | 23537.47 |
| Total Medical Medicare Payment Amount | 17207.26 |
| Total Medical Medicare Standardized Payment Amount | 15685.92 |
| Average Age Of Beneficiaries | 56 |
| Number Of Beneficiaries Age Less65 | 98 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 47 |
| Number Of Male Beneficiaries | 81 |
| Number Of Non Hispanic White Beneficiaries | 83 |
| Number Of Black or African American Beneficiaries | 22 |
| 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 | 54 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.373 |