| National Provider Identifier [NPI]: | 1689866204 |
| Last Name Of The Provider | DAVIDSON |
| First Name Of The Provider | JEAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25 E LAUREL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | STRATFORD |
| Zip Code Of The Provider | 080841322 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Endocrinology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 988 |
| Number Of Medicare Beneficiaries | 423 |
| Total Submitted Charge Amount | 285494 |
| Total Medicare Allowed Amount | 141793.42 |
| Total Medicare Payment Amount | 104332 |
| Total Medicare Standardized Payment Amount | 97736.03 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Total Medical Medicare Standardized Payment Amount | |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 222 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 279 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | 340 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3454 |