| National Provider Identifier [NPI]: | 1356303051 |
| Last Name Of The Provider | KEIM |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 190 CAMPUS BLVD |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | WINCHESTER |
| Zip Code Of The Provider | 226012872 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 9806 |
| Number Of Medicare Beneficiaries | 948 |
| Total Submitted Charge Amount | 439841 |
| Total Medicare Allowed Amount | 319117.83 |
| Total Medicare Payment Amount | 229947.32 |
| Total Medicare Standardized Payment Amount | 235092.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 287 |
| Number Of Medicare Beneficiaries With Drug Services | 274 |
| Total Drug Submitted ChargeAmount | 7180 |
| Total Drug Medicare AllowedAmount | 5879.27 |
| Total Drug Medicare PaymentAmount | 5662.77 |
| Total Drug Medicare Standardized Payment Amount | 5662.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 9519 |
| Number Of Medicare Beneficiaries With Medical Services | 948 |
| Total Medical Submitted Charge Amount | 432661 |
| Total Medical Medicare Allowed Amount | 313238.56 |
| Total Medical Medicare Payment Amount | 224284.55 |
| Total Medical Medicare Standardized Payment Amount | 229429.99 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 454 |
| Number Of Beneficiaries Age 75 to 84 | 312 |
| Number Of Beneficiaries Age Greater 84 | 130 |
| Number Of Female Beneficiaries | 480 |
| Number Of Male Beneficiaries | 468 |
| Number Of Non Hispanic White Beneficiaries | 907 |
| Number Of Black or African American Beneficiaries | 21 |
| 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 | 877 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.1433 |