| National Provider Identifier [NPI]: | 1164409652 |
| Last Name Of The Provider | DAUGHERTY |
| First Name Of The Provider | JOHN |
| 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 | 4910 VALLEY VIEW BLVD NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROANOKE |
| Zip Code Of The Provider | 240122040 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 136 |
| Number Of Services | 7591 |
| Number Of Medicare Beneficiaries | 1181 |
| Total Submitted Charge Amount | 803564 |
| Total Medicare Allowed Amount | 299764.87 |
| Total Medicare Payment Amount | 211900.69 |
| Total Medicare Standardized Payment Amount | 218392.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1064 |
| Number Of Medicare Beneficiaries With Drug Services | 333 |
| Total Drug Submitted ChargeAmount | 35856 |
| Total Drug Medicare AllowedAmount | 13394.28 |
| Total Drug Medicare PaymentAmount | 12433.75 |
| Total Drug Medicare Standardized Payment Amount | 12433.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 123 |
| Number Of Medical Services | 6527 |
| Number Of Medicare Beneficiaries With Medical Services | 1180 |
| Total Medical Submitted Charge Amount | 767708 |
| Total Medical Medicare Allowed Amount | 286370.59 |
| Total Medical Medicare Payment Amount | 199466.94 |
| Total Medical Medicare Standardized Payment Amount | 205959.03 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 200 |
| Number Of Beneficiaries Age 65 to 74 | 529 |
| Number Of Beneficiaries Age 75 to 84 | 323 |
| Number Of Beneficiaries Age Greater 84 | 129 |
| Number Of Female Beneficiaries | 732 |
| Number Of Male Beneficiaries | 449 |
| Number Of Non Hispanic White Beneficiaries | 951 |
| Number Of Black or African American Beneficiaries | 210 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1008 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 173 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9057 |