| National Provider Identifier [NPI]: | 1962710780 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | DEMETRICE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 INDEPENDENCE PT STE 202 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREENVILLE |
| Zip Code Of The Provider | 296154536 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 212 |
| Number Of Services | 4317 |
| Number Of Medicare Beneficiaries | 2751 |
| Total Submitted Charge Amount | 505239 |
| Total Medicare Allowed Amount | 163909.44 |
| Total Medicare Payment Amount | 126113.9 |
| Total Medicare Standardized Payment Amount | 124138 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 212 |
| Number Of Medical Services | 4317 |
| Number Of Medicare Beneficiaries With Medical Services | 2751 |
| Total Medical Submitted Charge Amount | 505239 |
| Total Medical Medicare Allowed Amount | 163909.44 |
| Total Medical Medicare Payment Amount | 126113.9 |
| Total Medical Medicare Standardized Payment Amount | 124138 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 715 |
| Number Of Beneficiaries Age 65 to 74 | 985 |
| Number Of Beneficiaries Age 75 to 84 | 729 |
| Number Of Beneficiaries Age Greater 84 | 322 |
| Number Of Female Beneficiaries | 1475 |
| Number Of Male Beneficiaries | 1276 |
| Number Of Non Hispanic White Beneficiaries | 1821 |
| Number Of Black or African American Beneficiaries | 448 |
| Number Of AsianPacific Islander Beneficiaries | 130 |
| Number Of Hispanic Beneficiaries | 289 |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1912 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 839 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.4048 |