| National Provider Identifier [NPI]: | 1851582357 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10212 N GREENWOOD LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAYWARD |
| Zip Code Of The Provider | 548437220 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 2567 |
| Number Of Medicare Beneficiaries | 263 |
| Total Submitted Charge Amount | 241959.3 |
| Total Medicare Allowed Amount | 95799.37 |
| Total Medicare Payment Amount | 70615.39 |
| Total Medicare Standardized Payment Amount | 80944.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 1368 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 60948.86 |
| Total Drug Medicare AllowedAmount | 34657.2 |
| Total Drug Medicare PaymentAmount | 27016.48 |
| Total Drug Medicare Standardized Payment Amount | 27016.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 1199 |
| Number Of Medicare Beneficiaries With Medical Services | 263 |
| Total Medical Submitted Charge Amount | 181010.44 |
| Total Medical Medicare Allowed Amount | 61142.17 |
| Total Medical Medicare Payment Amount | 43598.91 |
| Total Medical Medicare Standardized Payment Amount | 53927.68 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 145 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 147 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 252 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 217 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8872 |