| National Provider Identifier [NPI]: | 1770563801 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3525 OLENTANGY RIVER RD |
| Street Address 2 Of The Provider | STE 5360 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432143937 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 214 |
| Number Of Services | 2398 |
| Number Of Medicare Beneficiaries | 1674 |
| Total Submitted Charge Amount | 728307.44 |
| Total Medicare Allowed Amount | 172416.07 |
| Total Medicare Payment Amount | 134017.33 |
| Total Medicare Standardized Payment Amount | 133157.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 99 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 9302 |
| Total Drug Medicare AllowedAmount | 391.36 |
| Total Drug Medicare PaymentAmount | 306.51 |
| Total Drug Medicare Standardized Payment Amount | 306.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 210 |
| Number Of Medical Services | 2299 |
| Number Of Medicare Beneficiaries With Medical Services | 1674 |
| Total Medical Submitted Charge Amount | 719005.44 |
| Total Medical Medicare Allowed Amount | 172024.71 |
| Total Medical Medicare Payment Amount | 133710.82 |
| Total Medical Medicare Standardized Payment Amount | 132851.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 300 |
| Number Of Beneficiaries Age 65 to 74 | 574 |
| Number Of Beneficiaries Age 75 to 84 | 528 |
| Number Of Beneficiaries Age Greater 84 | 272 |
| Number Of Female Beneficiaries | 937 |
| Number Of Male Beneficiaries | 737 |
| Number Of Non Hispanic White Beneficiaries | 1547 |
| Number Of Black or African American Beneficiaries | 86 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1203 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 471 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.7453 |