| National Provider Identifier [NPI]: | 1427025311 |
| Last Name Of The Provider | DAUGHERTY |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 123 BROYLES |
| Street Address 2 Of The Provider | |
| City Of The Provider | CAPE GIRARDEAU |
| Zip Code Of The Provider | 637019598 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 13212 |
| Number Of Medicare Beneficiaries | 2638 |
| Total Submitted Charge Amount | 668198.05 |
| Total Medicare Allowed Amount | 356645.82 |
| Total Medicare Payment Amount | 268039.27 |
| Total Medicare Standardized Payment Amount | 296156.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 117.6 |
| Total Drug Medicare AllowedAmount | 53.59 |
| Total Drug Medicare PaymentAmount | 42.03 |
| Total Drug Medicare Standardized Payment Amount | 42.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 13192 |
| Number Of Medicare Beneficiaries With Medical Services | 2638 |
| Total Medical Submitted Charge Amount | 668080.45 |
| Total Medical Medicare Allowed Amount | 356592.23 |
| Total Medical Medicare Payment Amount | 267997.24 |
| Total Medical Medicare Standardized Payment Amount | 296114.23 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 329 |
| Number Of Beneficiaries Age 65 to 74 | 409 |
| Number Of Beneficiaries Age 75 to 84 | 749 |
| Number Of Beneficiaries Age Greater 84 | 1151 |
| Number Of Female Beneficiaries | 1839 |
| Number Of Male Beneficiaries | 799 |
| Number Of Non Hispanic White Beneficiaries | 2506 |
| Number Of Black or African American Beneficiaries | 101 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 923 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1715 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 66 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 24 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9229 |