| National Provider Identifier [NPI]: | 1013038371 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4140 W MEMORIAL RD |
| Street Address 2 Of The Provider | SUITE 208 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731208366 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 1848 |
| Number Of Medicare Beneficiaries | 473 |
| Total Submitted Charge Amount | 407528 |
| Total Medicare Allowed Amount | 167338 |
| Total Medicare Payment Amount | 123252.59 |
| Total Medicare Standardized Payment Amount | 132334.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 112 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 4984 |
| Total Drug Medicare AllowedAmount | 2082.71 |
| Total Drug Medicare PaymentAmount | 1626.62 |
| Total Drug Medicare Standardized Payment Amount | 1626.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 77 |
| Number Of Medical Services | 1736 |
| Number Of Medicare Beneficiaries With Medical Services | 473 |
| Total Medical Submitted Charge Amount | 402544 |
| Total Medical Medicare Allowed Amount | 165255.29 |
| Total Medical Medicare Payment Amount | 121625.97 |
| Total Medical Medicare Standardized Payment Amount | 130708.15 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 246 |
| Number Of Beneficiaries Age 75 to 84 | 143 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 342 |
| Number Of Non Hispanic White Beneficiaries | 410 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 19 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 448 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1498 |