| National Provider Identifier [NPI]: | 1629341862 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 948 S MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BAXLEY |
| Zip Code Of The Provider | 315130138 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 641 |
| Number Of Medicare Beneficiaries | 70 |
| Total Submitted Charge Amount | 71925 |
| Total Medicare Allowed Amount | 22684.41 |
| Total Medicare Payment Amount | 17594.58 |
| Total Medicare Standardized Payment Amount | 21580.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 321 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 4005 |
| Total Drug Medicare AllowedAmount | 120.12 |
| Total Drug Medicare PaymentAmount | 92.3 |
| Total Drug Medicare Standardized Payment Amount | 92.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 320 |
| Number Of Medicare Beneficiaries With Medical Services | 70 |
| Total Medical Submitted Charge Amount | 67920 |
| Total Medical Medicare Allowed Amount | 22564.29 |
| Total Medical Medicare Payment Amount | 17502.28 |
| Total Medical Medicare Standardized Payment Amount | 21488.31 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 29 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 39 |
| Number Of Male Beneficiaries | 31 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 40 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8932 |