| National Provider Identifier [NPI]: | 1417970948 |
| Last Name Of The Provider | HENRICKS |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6311 S POINTE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339194901 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 126 |
| Number Of Services | 20689 |
| Number Of Medicare Beneficiaries | 690 |
| Total Submitted Charge Amount | 780608.24 |
| Total Medicare Allowed Amount | 771797.19 |
| Total Medicare Payment Amount | 612881.47 |
| Total Medicare Standardized Payment Amount | 596243.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 4542 |
| Number Of Medicare Beneficiaries With Drug Services | 307 |
| Total Drug Submitted ChargeAmount | 82215.38 |
| Total Drug Medicare AllowedAmount | 82157.49 |
| Total Drug Medicare PaymentAmount | 66946.22 |
| Total Drug Medicare Standardized Payment Amount | 66946.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 16147 |
| Number Of Medicare Beneficiaries With Medical Services | 690 |
| Total Medical Submitted Charge Amount | 698392.86 |
| Total Medical Medicare Allowed Amount | 689639.7 |
| Total Medical Medicare Payment Amount | 545935.25 |
| Total Medical Medicare Standardized Payment Amount | 529297.33 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 295 |
| Number Of Beneficiaries Age Greater 84 | 193 |
| Number Of Female Beneficiaries | 387 |
| Number Of Male Beneficiaries | 303 |
| Number Of Non Hispanic White Beneficiaries | 672 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2464 |