| National Provider Identifier [NPI]: | 1538187505 |
| Last Name Of The Provider | DODT |
| First Name Of The Provider | KEVEN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3920 ST FRANCIS WAY |
| Street Address 2 Of The Provider | SUITE 209 |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 479054917 |
| 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 | 62 |
| Number Of Services | 4621 |
| Number Of Medicare Beneficiaries | 1101 |
| Total Submitted Charge Amount | 688907 |
| Total Medicare Allowed Amount | 350521.78 |
| Total Medicare Payment Amount | 263616.63 |
| Total Medicare Standardized Payment Amount | 277783.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 180 |
| Number Of Medicare Beneficiaries With Drug Services | 153 |
| Total Drug Submitted ChargeAmount | 14019 |
| Total Drug Medicare AllowedAmount | 10343.23 |
| Total Drug Medicare PaymentAmount | 10136.03 |
| Total Drug Medicare Standardized Payment Amount | 10136.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 4441 |
| Number Of Medicare Beneficiaries With Medical Services | 1101 |
| Total Medical Submitted Charge Amount | 674888 |
| Total Medical Medicare Allowed Amount | 340178.55 |
| Total Medical Medicare Payment Amount | 253480.6 |
| Total Medical Medicare Standardized Payment Amount | 267647.94 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 272 |
| Number Of Beneficiaries Age 75 to 84 | 350 |
| Number Of Beneficiaries Age Greater 84 | 421 |
| Number Of Female Beneficiaries | 694 |
| Number Of Male Beneficiaries | 407 |
| Number Of Non Hispanic White Beneficiaries | 1058 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 886 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 215 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 39 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6055 |