| National Provider Identifier [NPI]: | 1104047893 |
| Last Name Of The Provider | DEBOER |
| First Name Of The Provider | MATTHEW |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 120 GATEWAY CIR UNIT 1 |
| Street Address 2 Of The Provider | CREDENTIALING DEPARTMENT |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322594083 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 921 |
| Number Of Medicare Beneficiaries | 224 |
| Total Submitted Charge Amount | 104237 |
| Total Medicare Allowed Amount | 60433.94 |
| Total Medicare Payment Amount | 42666.8 |
| Total Medicare Standardized Payment Amount | 43521.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 69 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 3463 |
| Total Drug Medicare AllowedAmount | 1877.25 |
| Total Drug Medicare PaymentAmount | 1805.48 |
| Total Drug Medicare Standardized Payment Amount | 1805.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 852 |
| Number Of Medicare Beneficiaries With Medical Services | 224 |
| Total Medical Submitted Charge Amount | 100774 |
| Total Medical Medicare Allowed Amount | 58556.69 |
| Total Medical Medicare Payment Amount | 40861.32 |
| Total Medical Medicare Standardized Payment Amount | 41716.35 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 113 |
| Number Of Non Hispanic White Beneficiaries | 199 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8677 |