| National Provider Identifier [NPI]: | 1851549711 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | HEATHER |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 121 E MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 424501268 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 2653 |
| Number Of Medicare Beneficiaries | 223 |
| Total Submitted Charge Amount | 87541 |
| Total Medicare Allowed Amount | 41913.65 |
| Total Medicare Payment Amount | 28612.22 |
| Total Medicare Standardized Payment Amount | 36279.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 1522 |
| Number Of Medicare Beneficiaries With Drug Services | 129 |
| Total Drug Submitted ChargeAmount | 7605 |
| Total Drug Medicare AllowedAmount | 3890.47 |
| Total Drug Medicare PaymentAmount | 2933.65 |
| Total Drug Medicare Standardized Payment Amount | 2933.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 1131 |
| Number Of Medicare Beneficiaries With Medical Services | 223 |
| Total Medical Submitted Charge Amount | 79936 |
| Total Medical Medicare Allowed Amount | 38023.18 |
| Total Medical Medicare Payment Amount | 25678.57 |
| Total Medical Medicare Standardized Payment Amount | 33345.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 106 |
| 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 | 189 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.917 |