| National Provider Identifier [NPI]: | 1831176296 |
| Last Name Of The Provider | TOLLIVER |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 110 HUFFARD DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLUEFIELD |
| Zip Code Of The Provider | 246059209 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 17894 |
| Number Of Medicare Beneficiaries | 3317 |
| Total Submitted Charge Amount | 3466719.18 |
| Total Medicare Allowed Amount | 1860584.42 |
| Total Medicare Payment Amount | 1390128.08 |
| Total Medicare Standardized Payment Amount | 1399131.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 591 |
| Number Of Medicare Beneficiaries With Drug Services | 114 |
| Total Drug Submitted ChargeAmount | 15232 |
| Total Drug Medicare AllowedAmount | 10537.33 |
| Total Drug Medicare PaymentAmount | 7924.61 |
| Total Drug Medicare Standardized Payment Amount | 7924.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 118 |
| Number Of Medical Services | 17303 |
| Number Of Medicare Beneficiaries With Medical Services | 3317 |
| Total Medical Submitted Charge Amount | 3451487.18 |
| Total Medical Medicare Allowed Amount | 1850047.09 |
| Total Medical Medicare Payment Amount | 1382203.47 |
| Total Medical Medicare Standardized Payment Amount | 1391207 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 512 |
| Number Of Beneficiaries Age 65 to 74 | 1418 |
| Number Of Beneficiaries Age 75 to 84 | 1023 |
| Number Of Beneficiaries Age Greater 84 | 364 |
| Number Of Female Beneficiaries | 1663 |
| Number Of Male Beneficiaries | 1654 |
| Number Of Non Hispanic White Beneficiaries | 3226 |
| Number Of Black or African American Beneficiaries | 47 |
| 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 | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2779 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 538 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0495 |