| National Provider Identifier [NPI]: | 1245402262 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4331 CHURCHMAN AVE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402151164 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 5988 |
| Number Of Medicare Beneficiaries | 1016 |
| Total Submitted Charge Amount | 457698 |
| Total Medicare Allowed Amount | 186184.17 |
| Total Medicare Payment Amount | 138973.43 |
| Total Medicare Standardized Payment Amount | 172604.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2996 |
| Number Of Medicare Beneficiaries With Drug Services | 310 |
| Total Drug Submitted ChargeAmount | 47688 |
| Total Drug Medicare AllowedAmount | 33764.2 |
| Total Drug Medicare PaymentAmount | 25570.16 |
| Total Drug Medicare Standardized Payment Amount | 25570.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 2992 |
| Number Of Medicare Beneficiaries With Medical Services | 1016 |
| Total Medical Submitted Charge Amount | 410010 |
| Total Medical Medicare Allowed Amount | 152419.97 |
| Total Medical Medicare Payment Amount | 113403.27 |
| Total Medical Medicare Standardized Payment Amount | 147034.37 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 95 |
| Number Of Beneficiaries Age 65 to 74 | 350 |
| Number Of Beneficiaries Age 75 to 84 | 399 |
| Number Of Beneficiaries Age Greater 84 | 172 |
| Number Of Female Beneficiaries | 692 |
| Number Of Male Beneficiaries | 324 |
| Number Of Non Hispanic White Beneficiaries | 929 |
| Number Of Black or African American Beneficiaries | 59 |
| 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 | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 920 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.374 |