| National Provider Identifier [NPI]: | 1548320161 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 105 HOSPITAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAKDALE |
| Zip Code Of The Provider | 714633034 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 5247 |
| Number Of Medicare Beneficiaries | 618 |
| Total Submitted Charge Amount | 336495.5 |
| Total Medicare Allowed Amount | 237697.27 |
| Total Medicare Payment Amount | 166741.68 |
| Total Medicare Standardized Payment Amount | 179197.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 999 |
| Number Of Medicare Beneficiaries With Drug Services | 422 |
| Total Drug Submitted ChargeAmount | 22585 |
| Total Drug Medicare AllowedAmount | 13989.44 |
| Total Drug Medicare PaymentAmount | 12622.41 |
| Total Drug Medicare Standardized Payment Amount | 12622.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 4248 |
| Number Of Medicare Beneficiaries With Medical Services | 614 |
| Total Medical Submitted Charge Amount | 313910.5 |
| Total Medical Medicare Allowed Amount | 223707.83 |
| Total Medical Medicare Payment Amount | 154119.27 |
| Total Medical Medicare Standardized Payment Amount | 166575.4 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 69 |
| Number Of Beneficiaries Age 65 to 74 | 277 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 365 |
| Number Of Male Beneficiaries | 253 |
| Number Of Non Hispanic White Beneficiaries | 542 |
| 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 | 445 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 173 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1545 |