| National Provider Identifier [NPI]: | 1467424762 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1485 PARKWAY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | CRESCENT CITY |
| Zip Code Of The Provider | 955318502 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 7214 |
| Number Of Medicare Beneficiaries | 585 |
| Total Submitted Charge Amount | 501317.36 |
| Total Medicare Allowed Amount | 484419.59 |
| Total Medicare Payment Amount | 363398.96 |
| Total Medicare Standardized Payment Amount | 354632 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 481 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 92550.37 |
| Total Drug Medicare AllowedAmount | 90687.92 |
| Total Drug Medicare PaymentAmount | 70032.85 |
| Total Drug Medicare Standardized Payment Amount | 70032.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 6733 |
| Number Of Medicare Beneficiaries With Medical Services | 585 |
| Total Medical Submitted Charge Amount | 408766.99 |
| Total Medical Medicare Allowed Amount | 393731.67 |
| Total Medical Medicare Payment Amount | 293366.11 |
| Total Medical Medicare Standardized Payment Amount | 284599.15 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 237 |
| Number Of Beneficiaries Age 75 to 84 | 217 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 454 |
| Number Of Non Hispanic White Beneficiaries | 540 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 478 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1904 |