| National Provider Identifier [NPI]: | 1538150891 |
| Last Name Of The Provider | DEVANE |
| First Name Of The Provider | PHILIP |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1250 S 18TH ST |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | FERNANDINA BEACH |
| Zip Code Of The Provider | 320341902 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 9859 |
| Number Of Medicare Beneficiaries | 1554 |
| Total Submitted Charge Amount | 951295.58 |
| Total Medicare Allowed Amount | 630197.76 |
| Total Medicare Payment Amount | 465963.88 |
| Total Medicare Standardized Payment Amount | 471310.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 1056 |
| Number Of Medicare Beneficiaries With Drug Services | 464 |
| Total Drug Submitted ChargeAmount | 9842 |
| Total Drug Medicare AllowedAmount | 7671.12 |
| Total Drug Medicare PaymentAmount | 7340.41 |
| Total Drug Medicare Standardized Payment Amount | 7340.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 8803 |
| Number Of Medicare Beneficiaries With Medical Services | 1552 |
| Total Medical Submitted Charge Amount | 941453.58 |
| Total Medical Medicare Allowed Amount | 622526.64 |
| Total Medical Medicare Payment Amount | 458623.47 |
| Total Medical Medicare Standardized Payment Amount | 463969.81 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 846 |
| Number Of Beneficiaries Age 75 to 84 | 467 |
| Number Of Beneficiaries Age Greater 84 | 189 |
| Number Of Female Beneficiaries | 875 |
| Number Of Male Beneficiaries | 679 |
| Number Of Non Hispanic White Beneficiaries | 1485 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1507 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 0.9923 |