| National Provider Identifier [NPI]: | 1992885214 |
| Last Name Of The Provider | BURGESS |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2343 AARON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 339525305 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 16576 |
| Number Of Medicare Beneficiaries | 524 |
| Total Submitted Charge Amount | 897804.16 |
| Total Medicare Allowed Amount | 428903.92 |
| Total Medicare Payment Amount | 349712.63 |
| Total Medicare Standardized Payment Amount | 353596.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 28 |
| Number Of Drug Services | 4313 |
| Number Of Medicare Beneficiaries With Drug Services | 324 |
| Total Drug Submitted ChargeAmount | 107351.76 |
| Total Drug Medicare AllowedAmount | 54127.51 |
| Total Drug Medicare PaymentAmount | 43567.89 |
| Total Drug Medicare Standardized Payment Amount | 43567.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 12263 |
| Number Of Medicare Beneficiaries With Medical Services | 523 |
| Total Medical Submitted Charge Amount | 790452.4 |
| Total Medical Medicare Allowed Amount | 374776.41 |
| Total Medical Medicare Payment Amount | 306144.74 |
| Total Medical Medicare Standardized Payment Amount | 310028.42 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 184 |
| Number Of Beneficiaries Age 75 to 84 | 185 |
| Number Of Beneficiaries Age Greater 84 | 121 |
| Number Of Female Beneficiaries | 284 |
| Number Of Male Beneficiaries | 240 |
| Number Of Non Hispanic White Beneficiaries | 484 |
| Number Of Black or African American Beneficiaries | 25 |
| 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 | 485 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2966 |