| National Provider Identifier [NPI]: | 1780687954 |
| Last Name Of The Provider | PURVIS |
| First Name Of The Provider | HENRY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 658 NORTHSIDE DR E |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | STATESBORO |
| Zip Code Of The Provider | 304584828 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 125 |
| Number Of Services | 8487 |
| Number Of Medicare Beneficiaries | 895 |
| Total Submitted Charge Amount | 637456.61 |
| Total Medicare Allowed Amount | 269322.3 |
| Total Medicare Payment Amount | 209922.83 |
| Total Medicare Standardized Payment Amount | 222389.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 635 |
| Number Of Medicare Beneficiaries With Drug Services | 337 |
| Total Drug Submitted ChargeAmount | 25536.5 |
| Total Drug Medicare AllowedAmount | 13325.83 |
| Total Drug Medicare PaymentAmount | 12865.35 |
| Total Drug Medicare Standardized Payment Amount | 12865.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 7852 |
| Number Of Medicare Beneficiaries With Medical Services | 895 |
| Total Medical Submitted Charge Amount | 611920.11 |
| Total Medical Medicare Allowed Amount | 255996.47 |
| Total Medical Medicare Payment Amount | 197057.48 |
| Total Medical Medicare Standardized Payment Amount | 209523.82 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 91 |
| Number Of Beneficiaries Age 65 to 74 | 389 |
| Number Of Beneficiaries Age 75 to 84 | 299 |
| Number Of Beneficiaries Age Greater 84 | 116 |
| Number Of Female Beneficiaries | 527 |
| Number Of Male Beneficiaries | 368 |
| Number Of Non Hispanic White Beneficiaries | 774 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 731 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 164 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0722 |