| National Provider Identifier [NPI]: | 1417949678 |
| Last Name Of The Provider | DOUGLASS |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 955 BROADWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | BANGOR |
| Zip Code Of The Provider | 044012918 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 6530 |
| Number Of Medicare Beneficiaries | 876 |
| Total Submitted Charge Amount | 282161 |
| Total Medicare Allowed Amount | 181817.31 |
| Total Medicare Payment Amount | 121200.39 |
| Total Medicare Standardized Payment Amount | 131559.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 6530 |
| Number Of Medicare Beneficiaries With Medical Services | 876 |
| Total Medical Submitted Charge Amount | 282161 |
| Total Medical Medicare Allowed Amount | 181817.31 |
| Total Medical Medicare Payment Amount | 121200.39 |
| Total Medical Medicare Standardized Payment Amount | 131559.15 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 368 |
| Number Of Beneficiaries Age 75 to 84 | 286 |
| Number Of Beneficiaries Age Greater 84 | 161 |
| Number Of Female Beneficiaries | 558 |
| Number Of Male Beneficiaries | 318 |
| Number Of Non Hispanic White Beneficiaries | 851 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 704 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 172 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| 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 | 0.9934 |