| National Provider Identifier [NPI]: | 1477556785 |
| Last Name Of The Provider | DAVINA |
| First Name Of The Provider | ELEANOR |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3619 LAKE CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT DORA |
| Zip Code Of The Provider | 327572364 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 21727 |
| Number Of Medicare Beneficiaries | 1081 |
| Total Submitted Charge Amount | 1588687.5 |
| Total Medicare Allowed Amount | 763046.46 |
| Total Medicare Payment Amount | 621256.04 |
| Total Medicare Standardized Payment Amount | 627772.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 221 |
| Number Of Medicare Beneficiaries With Drug Services | 154 |
| Total Drug Submitted ChargeAmount | 10540 |
| Total Drug Medicare AllowedAmount | 5365.91 |
| Total Drug Medicare PaymentAmount | 5190.25 |
| Total Drug Medicare Standardized Payment Amount | 5190.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 120 |
| Number Of Medical Services | 21506 |
| Number Of Medicare Beneficiaries With Medical Services | 1081 |
| Total Medical Submitted Charge Amount | 1578147.5 |
| Total Medical Medicare Allowed Amount | 757680.55 |
| Total Medical Medicare Payment Amount | 616065.79 |
| Total Medical Medicare Standardized Payment Amount | 622582.22 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 523 |
| Number Of Beneficiaries Age 75 to 84 | 345 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 765 |
| Number Of Male Beneficiaries | 316 |
| Number Of Non Hispanic White Beneficiaries | 1051 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1020 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0455 |