| National Provider Identifier [NPI]: | 1174587315 |
| Last Name Of The Provider | PAYTON |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.D.S. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 NW 82ND AVE |
| Street Address 2 Of The Provider | SUITE 101-102 |
| City Of The Provider | PLANTATION |
| Zip Code Of The Provider | 333247809 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Oral Surgery (dentists only) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 345 |
| Number Of Medicare Beneficiaries | 137 |
| Total Submitted Charge Amount | 189162.24 |
| Total Medicare Allowed Amount | 109138.98 |
| Total Medicare Payment Amount | 84521.05 |
| Total Medicare Standardized Payment Amount | 82101.79 |
| 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 | 45 |
| Number Of Medical Services | 345 |
| Number Of Medicare Beneficiaries With Medical Services | 137 |
| Total Medical Submitted Charge Amount | 189162.24 |
| Total Medical Medicare Allowed Amount | 109138.98 |
| Total Medical Medicare Payment Amount | 84521.05 |
| Total Medical Medicare Standardized Payment Amount | 82101.79 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 48 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 74 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 84 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 87 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5286 |