| National Provider Identifier [NPI]: | 1720011695 |
| Last Name Of The Provider | DOHERTY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 N STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392164500 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 3723 |
| Number Of Medicare Beneficiaries | 2257 |
| Total Submitted Charge Amount | 293187 |
| Total Medicare Allowed Amount | 74271.91 |
| Total Medicare Payment Amount | 57133.68 |
| Total Medicare Standardized Payment Amount | 60253.14 |
| 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 | 55 |
| Number Of Medical Services | 3723 |
| Number Of Medicare Beneficiaries With Medical Services | 2257 |
| Total Medical Submitted Charge Amount | 293187 |
| Total Medical Medicare Allowed Amount | 74271.91 |
| Total Medical Medicare Payment Amount | 57133.68 |
| Total Medical Medicare Standardized Payment Amount | 60253.14 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 861 |
| Number Of Beneficiaries Age 65 to 74 | 769 |
| Number Of Beneficiaries Age 75 to 84 | 424 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 1158 |
| Number Of Male Beneficiaries | 1099 |
| Number Of Non Hispanic White Beneficiaries | 1080 |
| Number Of Black or African American Beneficiaries | 1132 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1088 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1169 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.3924 |