| National Provider Identifier [NPI]: | 1568477172 |
| Last Name Of The Provider | DODWELL |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1230 CENTRE WEST DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 62704 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 14541 |
| Number Of Medicare Beneficiaries | 916 |
| Total Submitted Charge Amount | 4012710.54 |
| Total Medicare Allowed Amount | 2308516.1 |
| Total Medicare Payment Amount | 1774414.25 |
| Total Medicare Standardized Payment Amount | 1802922.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 4679 |
| Number Of Medicare Beneficiaries With Drug Services | 328 |
| Total Drug Submitted ChargeAmount | 1571559.54 |
| Total Drug Medicare AllowedAmount | 1469319.26 |
| Total Drug Medicare PaymentAmount | 1151774.33 |
| Total Drug Medicare Standardized Payment Amount | 1151774.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 9862 |
| Number Of Medicare Beneficiaries With Medical Services | 916 |
| Total Medical Submitted Charge Amount | 2441151 |
| Total Medical Medicare Allowed Amount | 839196.84 |
| Total Medical Medicare Payment Amount | 622639.92 |
| Total Medical Medicare Standardized Payment Amount | 651148.59 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 278 |
| Number Of Beneficiaries Age 75 to 84 | 322 |
| Number Of Beneficiaries Age Greater 84 | 264 |
| Number Of Female Beneficiaries | 539 |
| Number Of Male Beneficiaries | 377 |
| Number Of Non Hispanic White Beneficiaries | 878 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 848 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3801 |