| National Provider Identifier [NPI]: | 1093710097 |
| Last Name Of The Provider | SOVRAN |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 211 EAST RUBY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | KISSIMME |
| Zip Code Of The Provider | 347415679 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 5028 |
| Number Of Medicare Beneficiaries | 475 |
| Total Submitted Charge Amount | 409682 |
| Total Medicare Allowed Amount | 259486.95 |
| Total Medicare Payment Amount | 198096.13 |
| Total Medicare Standardized Payment Amount | 199115.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 661 |
| Number Of Medicare Beneficiaries With Drug Services | 214 |
| Total Drug Submitted ChargeAmount | 16319 |
| Total Drug Medicare AllowedAmount | 10912.25 |
| Total Drug Medicare PaymentAmount | 9673.87 |
| Total Drug Medicare Standardized Payment Amount | 9673.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 4367 |
| Number Of Medicare Beneficiaries With Medical Services | 475 |
| Total Medical Submitted Charge Amount | 393363 |
| Total Medical Medicare Allowed Amount | 248574.7 |
| Total Medical Medicare Payment Amount | 188422.26 |
| Total Medical Medicare Standardized Payment Amount | 189441.76 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 196 |
| Number Of Beneficiaries Age 75 to 84 | 171 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 258 |
| Number Of Male Beneficiaries | 217 |
| Number Of Non Hispanic White Beneficiaries | 426 |
| Number Of Black or African American Beneficiaries | 30 |
| 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 | 461 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9478 |