| National Provider Identifier [NPI]: | 1306814678 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1069 DELAWARE AVE |
| Street Address 2 Of The Provider | SUITE 205B |
| City Of The Provider | MARION |
| Zip Code Of The Provider | 433021400 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 3189 |
| Number Of Medicare Beneficiaries | 562 |
| Total Submitted Charge Amount | 276858.5 |
| Total Medicare Allowed Amount | 158999.87 |
| Total Medicare Payment Amount | 115261.28 |
| Total Medicare Standardized Payment Amount | 119499.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 444 |
| Number Of Medicare Beneficiaries With Drug Services | 179 |
| Total Drug Submitted ChargeAmount | 16430 |
| Total Drug Medicare AllowedAmount | 9311.51 |
| Total Drug Medicare PaymentAmount | 8508.43 |
| Total Drug Medicare Standardized Payment Amount | 8508.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 2745 |
| Number Of Medicare Beneficiaries With Medical Services | 562 |
| Total Medical Submitted Charge Amount | 260428.5 |
| Total Medical Medicare Allowed Amount | 149688.36 |
| Total Medical Medicare Payment Amount | 106752.85 |
| Total Medical Medicare Standardized Payment Amount | 110991.45 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 242 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 349 |
| Number Of Male Beneficiaries | 213 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 478 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 84 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| 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 | 21 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.1813 |