| National Provider Identifier [NPI]: | 1134402555 |
| Last Name Of The Provider | MCDOUGAL |
| First Name Of The Provider | JAY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ATHENS |
| Zip Code Of The Provider | 457011856 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 1210 |
| Number Of Medicare Beneficiaries | 278 |
| Total Submitted Charge Amount | 120636 |
| Total Medicare Allowed Amount | 105845.15 |
| Total Medicare Payment Amount | 78088.27 |
| Total Medicare Standardized Payment Amount | 82923.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 577 |
| Total Drug Medicare AllowedAmount | 196.1 |
| Total Drug Medicare PaymentAmount | 159.92 |
| Total Drug Medicare Standardized Payment Amount | 159.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1185 |
| Number Of Medicare Beneficiaries With Medical Services | 278 |
| Total Medical Submitted Charge Amount | 120059 |
| Total Medical Medicare Allowed Amount | 105649.05 |
| Total Medical Medicare Payment Amount | 77928.35 |
| Total Medical Medicare Standardized Payment Amount | 82764.03 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 46 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 154 |
| Number Of Male Beneficiaries | 124 |
| Number Of Non Hispanic White Beneficiaries | 264 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 119 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 159 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5074 |