| National Provider Identifier [NPI]: | 1053416313 |
| Last Name Of The Provider | DOUGLAS |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 PROSPEROUS PL |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | LEXINGTON |
| Zip Code Of The Provider | 405091882 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 3188 |
| Number Of Medicare Beneficiaries | 215 |
| Total Submitted Charge Amount | 515829 |
| Total Medicare Allowed Amount | 146768.24 |
| Total Medicare Payment Amount | 108339.75 |
| Total Medicare Standardized Payment Amount | 99390.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1769 |
| Number Of Medicare Beneficiaries With Drug Services | 116 |
| Total Drug Submitted ChargeAmount | 38862 |
| Total Drug Medicare AllowedAmount | 3239.08 |
| Total Drug Medicare PaymentAmount | 2483.23 |
| Total Drug Medicare Standardized Payment Amount | 2483.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1419 |
| Number Of Medicare Beneficiaries With Medical Services | 215 |
| Total Medical Submitted Charge Amount | 476967 |
| Total Medical Medicare Allowed Amount | 143529.16 |
| Total Medical Medicare Payment Amount | 105856.52 |
| Total Medical Medicare Standardized Payment Amount | 96906.97 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 143 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | 202 |
| 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 | 154 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0933 |