| National Provider Identifier [NPI]: | 1912292590 |
| Last Name Of The Provider | DOCKRY |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 697 THOMAS LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432143931 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 300 |
| Number Of Medicare Beneficiaries | 116 |
| Total Submitted Charge Amount | 24203 |
| Total Medicare Allowed Amount | 19074 |
| Total Medicare Payment Amount | 15715.22 |
| Total Medicare Standardized Payment Amount | 16429.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 1424 |
| Total Drug Medicare AllowedAmount | 847.15 |
| Total Drug Medicare PaymentAmount | 829.78 |
| Total Drug Medicare Standardized Payment Amount | 829.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 256 |
| Number Of Medicare Beneficiaries With Medical Services | 115 |
| Total Medical Submitted Charge Amount | 22779 |
| Total Medical Medicare Allowed Amount | 18226.85 |
| Total Medical Medicare Payment Amount | 14885.44 |
| Total Medical Medicare Standardized Payment Amount | 15599.78 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 61 |
| Number Of Male Beneficiaries | 55 |
| Number Of Non Hispanic White Beneficiaries | 96 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9083 |