| National Provider Identifier [NPI]: | 1467447938 |
| Last Name Of The Provider | DAUGHERTY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2400 OSLER CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALBANY |
| Zip Code Of The Provider | 317070205 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 112 |
| Number Of Services | 10273 |
| Number Of Medicare Beneficiaries | 824 |
| Total Submitted Charge Amount | 1527722.4 |
| Total Medicare Allowed Amount | 343790.9 |
| Total Medicare Payment Amount | 262816.16 |
| Total Medicare Standardized Payment Amount | 272544.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 3196 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 124192 |
| Total Drug Medicare AllowedAmount | 43888.46 |
| Total Drug Medicare PaymentAmount | 34221.71 |
| Total Drug Medicare Standardized Payment Amount | 34221.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 7077 |
| Number Of Medicare Beneficiaries With Medical Services | 824 |
| Total Medical Submitted Charge Amount | 1403530.4 |
| Total Medical Medicare Allowed Amount | 299902.44 |
| Total Medical Medicare Payment Amount | 228594.45 |
| Total Medical Medicare Standardized Payment Amount | 238323.25 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 380 |
| Number Of Beneficiaries Age 75 to 84 | 277 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 265 |
| Number Of Male Beneficiaries | 559 |
| Number Of Non Hispanic White Beneficiaries | 626 |
| Number Of Black or African American Beneficiaries | 181 |
| 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 | 714 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 110 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.217 |