| National Provider Identifier [NPI]: | 1518248699 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | SHELLY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1801 ASHLEY CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOWLING GREEN |
| Zip Code Of The Provider | 421043362 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 333 |
| Number Of Medicare Beneficiaries | 292 |
| Total Submitted Charge Amount | 299074 |
| Total Medicare Allowed Amount | 35510.89 |
| Total Medicare Payment Amount | 27387.51 |
| Total Medicare Standardized Payment Amount | 33497.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 333 |
| Number Of Medicare Beneficiaries With Medical Services | 292 |
| Total Medical Submitted Charge Amount | 299074 |
| Total Medical Medicare Allowed Amount | 35510.89 |
| Total Medical Medicare Payment Amount | 27387.51 |
| Total Medical Medicare Standardized Payment Amount | 33497.83 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 143 |
| Number Of Beneficiaries Age 65 to 74 | 67 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 176 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 267 |
| Number Of Black or African American Beneficiaries | |
| 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 | 127 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 165 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5252 |