| National Provider Identifier [NPI]: | 1336111210 |
| Last Name Of The Provider | CAVANAGH |
| First Name Of The Provider | LAMONT |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1111 S ST LOUIS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 74120 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 913 |
| Number Of Medicare Beneficiaries | 187 |
| Total Submitted Charge Amount | 81623 |
| Total Medicare Allowed Amount | 43419.02 |
| Total Medicare Payment Amount | 32276.58 |
| Total Medicare Standardized Payment Amount | 34326.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 342 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 10423 |
| Total Drug Medicare AllowedAmount | 6244.66 |
| Total Drug Medicare PaymentAmount | 4501.48 |
| Total Drug Medicare Standardized Payment Amount | 4501.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 571 |
| Number Of Medicare Beneficiaries With Medical Services | 184 |
| Total Medical Submitted Charge Amount | 71200 |
| Total Medical Medicare Allowed Amount | 37174.36 |
| Total Medical Medicare Payment Amount | 27775.1 |
| Total Medical Medicare Standardized Payment Amount | 29824.81 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 103 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | 103 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 57 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4689 |