| National Provider Identifier [NPI]: | 1588767826 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | OMAR |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4385 MONTELEONE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKELAND |
| Zip Code Of The Provider | 38002 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 47044 |
| Number Of Medicare Beneficiaries | 514 |
| Total Submitted Charge Amount | 6899246.6 |
| Total Medicare Allowed Amount | 1743917.21 |
| Total Medicare Payment Amount | 1325802.34 |
| Total Medicare Standardized Payment Amount | 1516074.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 43952 |
| Number Of Medicare Beneficiaries With Drug Services | 467 |
| Total Drug Submitted ChargeAmount | 106842.6 |
| Total Drug Medicare AllowedAmount | 8824.22 |
| Total Drug Medicare PaymentAmount | 6743.36 |
| Total Drug Medicare Standardized Payment Amount | 6743.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 3092 |
| Number Of Medicare Beneficiaries With Medical Services | 514 |
| Total Medical Submitted Charge Amount | 6792404 |
| Total Medical Medicare Allowed Amount | 1735092.99 |
| Total Medical Medicare Payment Amount | 1319058.98 |
| Total Medical Medicare Standardized Payment Amount | 1509330.78 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 308 |
| Number Of Beneficiaries Age 65 to 74 | 128 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 262 |
| Number Of Male Beneficiaries | 252 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 438 |
| 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 | 243 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 271 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 62 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 73 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 7.9548 |