| National Provider Identifier [NPI]: | 1518924513 |
| Last Name Of The Provider | DAVISON |
| First Name Of The Provider | GLENN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 222 S WOODS MILL RD |
| Street Address 2 Of The Provider | SUITE 510 NORTH |
| City Of The Provider | CHESTERFIELD |
| Zip Code Of The Provider | 630173625 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 5033 |
| Number Of Medicare Beneficiaries | 2680 |
| Total Submitted Charge Amount | 487561 |
| Total Medicare Allowed Amount | 213209.99 |
| Total Medicare Payment Amount | 159440.2 |
| Total Medicare Standardized Payment Amount | 162466.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 5880 |
| Total Drug Medicare AllowedAmount | 2965.08 |
| Total Drug Medicare PaymentAmount | 2324.61 |
| Total Drug Medicare Standardized Payment Amount | 2324.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 4977 |
| Number Of Medicare Beneficiaries With Medical Services | 2680 |
| Total Medical Submitted Charge Amount | 481681 |
| Total Medical Medicare Allowed Amount | 210244.91 |
| Total Medical Medicare Payment Amount | 157115.59 |
| Total Medical Medicare Standardized Payment Amount | 160142.18 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 189 |
| Number Of Beneficiaries Age 65 to 74 | 955 |
| Number Of Beneficiaries Age 75 to 84 | 901 |
| Number Of Beneficiaries Age Greater 84 | 635 |
| Number Of Female Beneficiaries | 1444 |
| Number Of Male Beneficiaries | 1236 |
| Number Of Non Hispanic White Beneficiaries | 2470 |
| Number Of Black or African American Beneficiaries | 142 |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2450 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 230 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6299 |