| National Provider Identifier [NPI]: | 1760653505 |
| Last Name Of The Provider | DAVENPORT |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 W FOREST AVE |
| Street Address 2 Of The Provider | STE 300 |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 383013937 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 131 |
| Number Of Services | 13910 |
| Number Of Medicare Beneficiaries | 831 |
| Total Submitted Charge Amount | 1120725.21 |
| Total Medicare Allowed Amount | 419406.14 |
| Total Medicare Payment Amount | 323640.72 |
| Total Medicare Standardized Payment Amount | 346306.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 8082 |
| Number Of Medicare Beneficiaries With Drug Services | 73 |
| Total Drug Submitted ChargeAmount | 85209 |
| Total Drug Medicare AllowedAmount | 36733.61 |
| Total Drug Medicare PaymentAmount | 28672.27 |
| Total Drug Medicare Standardized Payment Amount | 28672.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 123 |
| Number Of Medical Services | 5828 |
| Number Of Medicare Beneficiaries With Medical Services | 831 |
| Total Medical Submitted Charge Amount | 1035516.21 |
| Total Medical Medicare Allowed Amount | 382672.53 |
| Total Medical Medicare Payment Amount | 294968.45 |
| Total Medical Medicare Standardized Payment Amount | 317634.11 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 382 |
| Number Of Beneficiaries Age 75 to 84 | 261 |
| Number Of Beneficiaries Age Greater 84 | 86 |
| Number Of Female Beneficiaries | 314 |
| Number Of Male Beneficiaries | 517 |
| Number Of Non Hispanic White Beneficiaries | 717 |
| Number Of Black or African American Beneficiaries | 103 |
| 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 | 677 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 154 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3049 |