| National Provider Identifier [NPI]: | 1154389906 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | WINSTON |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 714 N SENATE AVE |
| Street Address 2 Of The Provider | STE EF205 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462023763 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 983 |
| Number Of Medicare Beneficiaries | 325 |
| Total Submitted Charge Amount | 1040941 |
| Total Medicare Allowed Amount | 114625.72 |
| Total Medicare Payment Amount | 88996.33 |
| Total Medicare Standardized Payment Amount | 91896.82 |
| 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 | 122 |
| Number Of Medical Services | 983 |
| Number Of Medicare Beneficiaries With Medical Services | 325 |
| Total Medical Submitted Charge Amount | 1040941 |
| Total Medical Medicare Allowed Amount | 114625.72 |
| Total Medical Medicare Payment Amount | 88996.33 |
| Total Medical Medicare Standardized Payment Amount | 91896.82 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 150 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 146 |
| Number Of Male Beneficiaries | 179 |
| Number Of Non Hispanic White Beneficiaries | 201 |
| Number Of Black or African American Beneficiaries | 113 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 144 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 181 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 68 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 4.1948 |