| National Provider Identifier [NPI]: | 1851585004 |
| Last Name Of The Provider | IVORY |
| First Name Of The Provider | DEDRI |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104 MCAULEY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | VICKSBURG |
| Zip Code Of The Provider | 391832825 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 18347 |
| Number Of Medicare Beneficiaries | 427 |
| Total Submitted Charge Amount | 661587 |
| Total Medicare Allowed Amount | 298940.01 |
| Total Medicare Payment Amount | 220502.3 |
| Total Medicare Standardized Payment Amount | 231537.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 16696 |
| Number Of Medicare Beneficiaries With Drug Services | 175 |
| Total Drug Submitted ChargeAmount | 440197 |
| Total Drug Medicare AllowedAmount | 179960.6 |
| Total Drug Medicare PaymentAmount | 139353.37 |
| Total Drug Medicare Standardized Payment Amount | 139353.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1651 |
| Number Of Medicare Beneficiaries With Medical Services | 427 |
| Total Medical Submitted Charge Amount | 221390 |
| Total Medical Medicare Allowed Amount | 118979.41 |
| Total Medical Medicare Payment Amount | 81148.93 |
| Total Medical Medicare Standardized Payment Amount | 92184.44 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 145 |
| Number Of Beneficiaries Age 65 to 74 | 164 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 353 |
| Number Of Male Beneficiaries | 74 |
| Number Of Non Hispanic White Beneficiaries | 225 |
| 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 | 278 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 149 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2361 |