| National Provider Identifier [NPI]: | 1578654125 |
| Last Name Of The Provider | DONAHOE |
| First Name Of The Provider | EDGAR |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 122 E BAKER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | INDIANOLA |
| Zip Code Of The Provider | 387512451 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 1724 |
| Number Of Medicare Beneficiaries | 258 |
| Total Submitted Charge Amount | 195804.8 |
| Total Medicare Allowed Amount | 118776.31 |
| Total Medicare Payment Amount | 87772.29 |
| Total Medicare Standardized Payment Amount | 79235.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 113 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1114.8 |
| Total Drug Medicare AllowedAmount | 390.99 |
| Total Drug Medicare PaymentAmount | 45.42 |
| Total Drug Medicare Standardized Payment Amount | 45.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 77 |
| Number Of Medical Services | 1611 |
| Number Of Medicare Beneficiaries With Medical Services | 258 |
| Total Medical Submitted Charge Amount | 194690 |
| Total Medical Medicare Allowed Amount | 118385.32 |
| Total Medical Medicare Payment Amount | 87726.87 |
| Total Medical Medicare Standardized Payment Amount | 79190.11 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 159 |
| Number Of Male Beneficiaries | 99 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 133 |
| 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 | 141 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6329 |