| National Provider Identifier [NPI]: | 1396733101 |
| Last Name Of The Provider | DAVID |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1815 E IRELAND RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 466142845 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 2400 |
| Number Of Medicare Beneficiaries | 565 |
| Total Submitted Charge Amount | 182259 |
| Total Medicare Allowed Amount | 110415.02 |
| Total Medicare Payment Amount | 75615.39 |
| Total Medicare Standardized Payment Amount | 80710.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 313 |
| Number Of Medicare Beneficiaries With Drug Services | 158 |
| Total Drug Submitted ChargeAmount | 5939 |
| Total Drug Medicare AllowedAmount | 3349.07 |
| Total Drug Medicare PaymentAmount | 3168.24 |
| Total Drug Medicare Standardized Payment Amount | 3168.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 2087 |
| Number Of Medicare Beneficiaries With Medical Services | 565 |
| Total Medical Submitted Charge Amount | 176320 |
| Total Medical Medicare Allowed Amount | 107065.95 |
| Total Medical Medicare Payment Amount | 72447.15 |
| Total Medical Medicare Standardized Payment Amount | 77541.81 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 219 |
| Number Of Beneficiaries Age 75 to 84 | 181 |
| Number Of Beneficiaries Age Greater 84 | 115 |
| Number Of Female Beneficiaries | 318 |
| Number Of Male Beneficiaries | 247 |
| Number Of Non Hispanic White Beneficiaries | 528 |
| Number Of Black or African American Beneficiaries | 17 |
| 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 | 475 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.085 |