| National Provider Identifier [NPI]: | 1689617813 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | GLEN |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4106 W LAKE MARY BLVD |
| Street Address 2 Of The Provider | SUITE 301 |
| City Of The Provider | LAKE MARY |
| Zip Code Of The Provider | 327463315 |
| 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 | 49 |
| Number Of Services | 16124 |
| Number Of Medicare Beneficiaries | 567 |
| Total Submitted Charge Amount | 634093 |
| Total Medicare Allowed Amount | 458776.98 |
| Total Medicare Payment Amount | 359720.43 |
| Total Medicare Standardized Payment Amount | 362961.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 678 |
| Number Of Medicare Beneficiaries With Drug Services | 397 |
| Total Drug Submitted ChargeAmount | 15568 |
| Total Drug Medicare AllowedAmount | 11402.99 |
| Total Drug Medicare PaymentAmount | 10931.02 |
| Total Drug Medicare Standardized Payment Amount | 10931.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 15446 |
| Number Of Medicare Beneficiaries With Medical Services | 567 |
| Total Medical Submitted Charge Amount | 618525 |
| Total Medical Medicare Allowed Amount | 447373.99 |
| Total Medical Medicare Payment Amount | 348789.41 |
| Total Medical Medicare Standardized Payment Amount | 352030.77 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 216 |
| Number Of Beneficiaries Age 75 to 84 | 201 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 316 |
| Number Of Male Beneficiaries | 251 |
| Number Of Non Hispanic White Beneficiaries | 534 |
| 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 | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 7 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1769 |